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VOLUME 12 , ISSUE 1 ( March, 2008 ) > List of Articles

CASE REPORT

Fat embolism syndrome: Clinical and imaging considerations: Case report and review of literature

Ashok Parchani, Nissar Shaikh, Venkatraman Bhat, Marie Anne Kattren

Keywords : Fat embolism syndrome, imaging, magnetic resonance imaging

Citation Information : Parchani A, Shaikh N, Bhat V, Kattren MA. Fat embolism syndrome: Clinical and imaging considerations: Case report and review of literature. Indian J Crit Care Med 2008; 12 (1):32-36.

DOI: 10.4103/0972-5229.40948

License: CC BY-ND 3.0

Published Online: 01-03-2008

Copyright Statement:  Copyright © 2008; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Fat embolism syndrome (FES) is a serious clinical disorder occurring after trauma, orthopedic procedures and rarely in non-traumatic patients. Fat emboli develop in nearly all patients with bone fractures, but they are usually asymptomatic. Small number of patients develop signs and symptoms of various organ system dysfunction due to either mechanical obstruction of capillaries by fat emboli or due to hydrolysis of fat to fatty acids. A triad of lung, brain and skin involvement develop after an asymptomatic period of 24 to 72 hours. This symptom complex is called FES. The incidence reported is up to 30%, but many mild cases may recover unnoticed. Diagnosis of fat embolism is clinical with nonspecific, insensitive diagnostic test results. Treatment of fat embolism syndrome remains supportive and in most cases can be prevented by early fixation of large bone factures. Here we report two cases of traumatic fat embolism, which were diagnosed initially by Gurd′s criteria and subsequently confirmed by typical appearance on magnetic resonance imaging (MRI) of the brain in these patients. These patients were successfully treated with supportive management. In conclusion, diagnosis of FES needs high index of suspicion, exclusion of other conditions and use of clinical criteria in combination with imaging. Magnetic resonance imaging of the brain is of great importance in diagnosis and management of these patients.


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  1. Ein fall todlicher fettenbolic. Berl Klin Wochenscher 1873;10:385.
  2. Beitraege zur normalen und pathologischen. Anatomie der Lungen. Dresden (DE): J Branunsdorf; 1862. p. 31.
  3. Fat embolism syndrome: Clinical examination is still the preferable diagnostic method. Chest 2003;123:982-3.
  4. Fat embolism syndrome, prospective evaluation in 92 fractured patients. Crit Care Med 1990;18:42-6.
  5. The Fat Embolism Syndrome. Injury 1997;28:77-85.
  6. Fat embolism syndrome: A review of pathology and physiological basis of treatment. Clin Orthop Relat Res 1982;165:68-82.
  7. Free fatty acids, catecholamine and arterial hypoxia in patients with fat embolism. Jr Trauma 1971;11:1026-30.
  8. The Fat embolism syndrome. J Bone Joint Surg Br 1974;56:408-16.
  9. Fat embolism and post operative coagulopathy. Can J Anaesth 2001;48:618-21.
  10. Fat embolism syndrome, etiology pathogenesis and treatment. Acta Chir Scand Suppl 1980;499:75-85.
  11. Fat embolism prophylaxis with corticosteriod: A prospective study in high risk patients. Ann Intern Med 1983;99:438-43.
  12. Traumatic fat embolism syndrome. Saudi Med J 2002;23:1532-6.
  13. Role of bronchoalveolar lavage in diagnosis of fat embolism syndrome. Eur Respir J 1995;8:1275-80.
  14. Reversible cytotoxic cerebral edema in cerebral fat embolism. AJNR Am J Neuroradiol 2006;27:620-3.
  15. Contrast-enhanced MR imaging of cerebral fat embolism: Case report and review of the literature. AJNR Am J Neuroradiol 2003;24:97-101.
  16. Magnetic resonance image findings in cerebral fat embolism correlation with clinical manifestations. J Trauma 1999;46:324-7.
  17. Diffusion weighted MRI imaging of global cerebral anoxia. AJNR Am J Neuroradiol 1999;20:999-1067.
  18. MRI findings in cerebral fat embolism. Eur Radiol 1998;8:1590-3.
  19. The role of rehydration in prevention of FES. Injury 2002;33:757-9.
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