Fat Embolism, Fat Embolism Syndrome and the Autopsy

Fat embolism is common following trauma and is a common autopsy finding in these cases. It may also be seen in non-traumatic cases and is seen in children as well as adults. In comparison fat embolism syndrome (FES) only occurs in a small number of trauma and non-trauma cases. Clinical diagnosis is based on characteristic clinical and laboratory findings. Fat embolism exerts its effect by mechanical blockage of vessels and/or by biochemical means including breakdown of fat to free fatty acids causing an inflammatory response. Fat embolism can be identified at autopsy on microscopy of the lungs using fat stains conducted on frozen tissue, including on formalin fixed but not processed tissue. With FES fat emboli can be seen in other organs including the brain, kidney and myocardium. Fat can also be identified with post-fixation staining, typically with osmium tetroxide. Scoring systems have been developed to try and determine the severity of fat embolism in lung tissue. Fat embolism is also common following resuscitation. When no resuscitation has taken place, the presence of fat on lung histology has been used as proof of vitality. Diagnosis of fat embolism syndrome at autopsy requires analysis of the history, clinical and laboratory findings along with autopsy investigations to determine its relevance, but is an important diagnosis to make which is not always identified clinically. This paper reviews the history, clinical and laboratory findings and diagnosis of fat embolism and fat embolism syndrome at autopsy.

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Fat Embolism Syndrome: A Case Report and Review Literature

Case Reports in Medicine ◽

10.1155/2018/1479850 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Nattaphol Uransilp ◽

Sombat Muengtaweepongsa ◽

Nuttawut Chanalithichai ◽

Nattapol Tammachote

Keyword(s):

Bone Fractures ◽

Specific Treatment ◽

Fat Embolism ◽

Review Literature ◽

Long Bone ◽

Laboratory Findings ◽

Fat Embolism Syndrome ◽

Embolism Syndrome ◽

Neck Fracture ◽

Magnetic Resonance Imaging Mri

Fat embolism syndrome (FES) is a life-threatening complication in patients with orthopedic trauma, especially long bone fractures. The diagnosis of fat embolism is made by clinical features alone with no specific laboratory findings. FES has no specific treatment and requires supportive care, although it can be prevented by early fixation of bone fractures. Here, we report a case of FES in a patient with right femoral neck fracture, which was diagnosed initially by Gurd’s criteria and subsequently confirmed by typical appearances on magnetic resonance imaging (MRI) of the brain. The patient received supportive management and a short course of intravenous methylprednisolone.

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MR imaging of the brain in fat embolism syndrome

Emergency Radiology ◽

10.1007/s10140-007-0664-3 ◽

2007 ◽

Vol 15 (3) ◽

pp. 187-192 ◽

Cited By ~ 21

Author(s):

Joseph Jen-Sho Chen ◽

James C. Ha ◽

Stuart E. Mirvis

Keyword(s):

Mr Imaging ◽

Fat Embolism ◽

Fat Embolism Syndrome ◽

Embolism Syndrome ◽

The Brain

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Coma secondary to cerebral fat embolism syndrome due to sickle cell disease fully recovering following red cell exchange transfusion

BMJ Case Reports ◽

10.1136/bcr-2021-245051 ◽

2021 ◽

Vol 14 (11) ◽

pp. e245051

Author(s):

Nourah Alajeel ◽

Kefaya Abdulmalek ◽

Abdulrahman Al-Fares

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Exchange Transfusion ◽

Fat Embolism ◽

Red Cell ◽

Cell Disease ◽

Fat Embolism Syndrome ◽

Epileptiform Discharges ◽

Embolism Syndrome ◽

The Brain

A 51-year-old woman known for sickle cell disease presented with 2 weeks of headache and bilateral lower limb pain. During admission, she suffered from multiple generalised tonic-clonic seizures but had an unremarkable CT of the brain. Incidentally, she had worsening baseline renal function. She was admitted to the intensive care unit with an acute confusional state. A bedside electroencephalogram showed triphasic waves and diffuse slow activity suggestive of encephalopathy with no epileptiform discharges. She remained obtunded despite appropriate medical therapy of hydration, antiepileptic and pain control. Lumbar puncture failed to identify an infectious cause. An urgent MRI of the brain was done and revealed features compatible with fat embolism syndrome (FES). Her haemoglobin S was 84.2%. Urgent red cell exchange transfusion was done, and within 3 days she fully regained her orientation and motor function. This represents the first case of such profound obtundation due to FES with a complete response to exchange transfusion.

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Magnetic Resonance Imaging of a Fat Embolism of the Brain: Case Report

Neurosurgery ◽

10.1227/00006123-199005000-00027 ◽

1990 ◽

Vol 26 (5) ◽

pp. 882-885 ◽

Cited By ~ 13

Author(s):

Atsushi Saito ◽

Kotoo Meguro ◽

Akira Matsumura ◽

Yoji Komatsu ◽

Noriyoshi Oohashi

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Fat Embolism ◽

Magnetic Resonance Imaging Scan ◽

Resonance Imaging ◽

Computed Tomographic ◽

Fat Embolism Syndrome ◽

Embolism Syndrome ◽

Cerebral Fat Embolism Syndrome ◽

The Brain

Abstract A 22-year-old man developed fat embolism syndrome. Although a computed tomographic (CT) scan of the brain showed nothing abnormal, a magnetic resonance imaging scan detected scattered spotty areas of low intensity on T1-weighted images and of high intensity on T2-weighted images. Magnetic resonance imaging is thought to be more sensitive than computed tomography in detecting cerebral fat embolism syndrome and correlates well with the clinical course.

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Clinical case of successful treatment of compartment syndrome, complicated by fat embolism syndrome

Practical medicine ◽

10.32000/2072-1757-2018-7-81-84 ◽

2018 ◽

Vol 16 (7(part 1)) ◽

pp. 81-84

Author(s):

I. O. Pankov ◽

◽

M. M. Gabdullin ◽

S. D. Sirazitdinov ◽

◽

...

Keyword(s):

Compartment Syndrome ◽

Successful Treatment ◽

Clinical Case ◽

Fat Embolism ◽

Fat Embolism Syndrome ◽

Embolism Syndrome

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Faculty Opinions recommendation of Fat Embolism Syndrome following minor trauma in Duchenne muscular dystrophy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717967460.793467115 ◽

2012 ◽

Author(s):

Francis Veyckemans

Keyword(s):

Duchenne Muscular Dystrophy ◽

Muscular Dystrophy ◽

Fat Embolism ◽

Minor Trauma ◽

Fat Embolism Syndrome ◽

Embolism Syndrome

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Late-onset isolated cerebral fat embolism syndrome after a simple tibial plateau fracture: a rare case report

Journal of International Medical Research ◽

10.1177/03000605211028415 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110284

Author(s):

Ta-Li Hsu ◽

Tien-Chi Li ◽

Fei-Pi Lai ◽

Ming Ouhyoung ◽

Chih-Hung Chang ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rare Case ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Fat Embolism ◽

Resonance Imaging ◽

Fat Embolism Syndrome ◽

Embolism Syndrome ◽

Plateau Fracture

Fat embolism syndrome (FES) is a complication of long bone fractures that often occurs within 72 hours of injury. Early-onset isolated cerebral fat embolism is catastrophic and rarely reported. We herein present a rare case of delayed-onset isolated cerebral FES that developed 10 days after definite fixation of a left tibial plateau fracture. A 70-year-old woman was injured in a traffic accident and diagnosed with a left tibial plateau fracture. However, she developed sudden loss of consciousness (E4V1M1) and quadriplegia 10 days after fracture fixation. Her vital signs showed no respiratory distress. Diagnosis of isolated cerebral FES was made based on magnetic resonance imaging of the brain, the findings of which were compatible with the clinical neurological findings. After supportive care and rehabilitation, her consciousness became clear on the second day of admission, and her consciousness changed to E4V5M6. She gradually regained strength in her right limbs but had residual left limb paraplegia. Isolated cerebral FES should always be considered for patients who develop a change in consciousness, even beyond 72 hours after injury. Imaging may not initially show definitive abnormalities. Repeated magnetic resonance imaging should be considered if the initial clinical presentation does not fully meet Gurd’s criteria.

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A rare case of fat embolism syndrome secondary to abdominal liposuction and gluteal fat infiltration

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa441 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Salvador Recinos ◽

Sabrina Barillas ◽

Alejandra Rodas ◽

Javier Ardebol

Keyword(s):

Right Ventricular Dysfunction ◽

Signs And Symptoms ◽

Fat Embolism ◽

Fat Infiltration ◽

Fat Embolism Syndrome ◽

Embolism Syndrome ◽

Threatening Condition ◽

Life Threatening ◽

Bone Marrow Harvesting ◽

Dermatologic Manifestations

Abstract Fat embolism syndrome (FES) is a rare, life-threatening condition habitually associated with traumatic events such as fractures and, less commonly, burns, liposuction and bone marrow harvesting and transplant [ 1]. The biochemical theory for this condition suggests that fat droplets embolize and convert into fatty acids, eventually leading to toxic injury and inflammation, which results in increased vascular permeability, edema and hemorrhage [ 2]. FES may have an asymptomatic interval lasting 12–72 hours after the insult; however, in some cases, signs have also been seen intraoperatively. Pulmonary signs and symptoms are customarily the earliest and manifest in 75% of patients. Nevertheless, neurologic and dermatologic manifestations are also characteristic, and most severe cases could perhaps present with disseminated intravascular coagulation, right ventricular dysfunction, shock or death. The following case consists of a 37-year-old patient that presented with fat embolism syndrome during liposuction and gluteal fat infiltration.

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