Causes, clinical manifestations, and treatment of fat embolism. Fat embolism syndrome fes is a known complication of sickle cell disease scd that occurs secondary to vasoocclusive crises, bone marrow infarction, and the subsequent release of fat globules into the venous circulation. Fat embolism syndrome fes is a constellation of clinical signs and symptoms that occurs following the release of fat emboli into systemic circulation, often in the setting of orthopedic trauma. Fat embolism syndrome fes is a serious manifestation of fe with an incidence of 0. Apr 29, 2018 fat embolism syndrome fes is a lifethreatening complication in patients with orthopedic trauma, especially long bone fractures. Fat embolism is usually asymptomatic, but in the minority of the patients symptoms and signs develop as a result of dysfunction of several organs, notably of the lungs. Emergency management of fat embolism syndrome request pdf. Clinical symptoms and computed tomography are not always diagnostic, while magnetic resonance imaging is. The classical picture ofcerebral confusion, respiratory distress and petechiae ofskin and mucosa isnot always seen. Fat embolism syndrome fes is a rare but potentially fatal complication of trauma or or thopedic surgery, which presents. Other symptoms may include fever and decreased urine output. Immobilization of longbone fractures and management of respiratory distress syndrome are appropriate.
This article covers the topic of fat embolism in general, and presents a case of fulminant fat embolism syndrome. Fes has no specific treatment and requires supportive care, although it can be prevented by early fixation of bone fractures. Fat embolism fe and fat embolism syndrome fes are a clinical phenomenon that are characterized by systemic dissemination of fat emboli within the system circulation. Fat embolism syndrome fes is a lifethreatening complication in patients with orthopedic trauma, especially long bone fractures. Fat embolism syndrome fes is a not common subacute syndrome caused by fat droplets and bone marrow entering systemic circulation and thus causing obstruction of pulmonary, cerebral and cutaneous. However, the fat globules and chylomicrons gain access to the systemic circulation and can also affect heart, brain, skin and retina. The fat embolism syndrome fes is a rare clinical condition in which circulating fat emboli or fat macroglobules lead to multisystem dysfunction. Fat embolism syndrome fes was first described in 1862, but its frequency today is still unclear. A fat embolism fe is a piece of intravascular fat that lodges within a blood vessel and causes a blockage of blood flow. The reported incidence varies greatly in the literature depending on diagnostic criteria.
Pdf fat embolism syndrome fes was first described in 1862, but its frequency today is still unclear. Cerebral fat embolism syndrome in sickle cell disease without. Fat embolism syndrome is a disease affecting mainly capillaries and mainly on the venous side. The fat embolism syndrome is believed to be caused by the toxic effects of free fatty acids liberated at the endothelial layer which cause capillary disruption. The true incidence is difficult to assess as many cases remain undiagnosed.
Fat emboli commonly occur after fractures to the long bones of the lower body, particularly the femur thighbone, tibia shinbone, and pelvis. Fat emboli commonly occur after fractures to the long bones of the lower. Usually it manifests within 72 h of initial insult. Pathophysiology and management of the fat embolism syndrome s. Intramedullary fat is the source of the fat embolism in patients who have fractures or during intramedullary surgical fixation during the latter procedure echocardiography has confirmed the embolic. Cerebral involvement varies from confusion to encephalopathy with coma and seizures. Fat embolism is a wellknown complication of long bone and pelvic fractures. The fat embolism syndrome is a symptom complex of acute respiratory failure after longbone fractures. Patients with the fat embousm syndrome are reported to have a severe course, with mortalityas high as 15 percent.
Peltier, an appraisal of the problem of fat embolism int. Fat embolism syndrome fes is a rare clinical syndrome that can complicate a wide variety of clinical conditions table 1, particularly those where fat is manipulated. Almost all cases of fes are due to long bone and pelvic fractures bone marrow contains a high content of fat. Fat embolism syndrome fes most commonly is associated with long bone and pelvic fractures, and is more. Rarely, systemic fat emboli can affect the heart and lead to mottled myocardial necrosis and full blown right heart syndrome. Pdf fat embolism syndrome fes is an illdefined clinical entity that arises from the systemic manifestations of fat emboli within the. The dissipation of fat emboli will disrupt the capillary bed and affect microcirculation, causing a systemic inflammatory response syndrome. Pdf fat embolism syndrome fes is a lifethreatening situation, which warrants greater emphasis than it receives in the literature. The subject of fat embolism is of recurring interest to those managing trauma. Treatment of fat embolism syndrome is supportive with early resucitation and stabalization to minimize the stress response to hypoxemia, hypotension, and diminished endorgan perfusion. Hence, the lung is the most common organ affected in fes. Recentstudies have attributedimproved prognosis to one or another treatment modauty.
The clinical background, chronology of symptoms and corroborative laboratory findings are instrumental in a. Pulmonary fat embolism is a specific subtype of pulmonary embolism where the embolic particles are composed of fat. It is thought to have been clinically described as a postmortem finding by zenker in 1862. A fulminant form of fat embolism syndrome occurs rarely, develops in minutes to hours, is associated with profound hypoxemia, hypotension and carries a high mortality 33. Fat embolism syndrome remains a rare, but potentially life threatening complication of long bone fractures. Cerebral manifestations of fat embolism syndrome can be highly variable and nonspecific. In all cases the classic triad of neurologic dysfunction, respiratory insufficiency, and petechiae were present. Fat particles or droplets that travel through the circulation fat embolism.
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. We report a case of a caucasian female with a near fatal fat embolism syndrome with multi organ involvement in. A very common early sign of fat embolism syndrome is fever. It is believed to be caused by the toxic effects of free fatty acids.
Fat embolism fe is defined by the presence of fat globules in the pulmonary microcirculation regardless of clinical significance. Pathophysiology and management of the fat embolism. Fat embolism syndrome develops most commonly after orthopedic injuries, but it has also been reported after other forms of trauma such as severe burns, liver injury, closedchest cardiac massage, bone marrow transplantation, and liposuction. Embolized fat within capillary beds cause direct tissue damage as well as induce a systemic inflammatory response resulting in pulmonary, cutaneous, neurological, and retinal symptoms. Its classic presentation consists of an asymptomatic interval followed by pulmonary and neurologic manifestations combined with petechial hemorrhages. Peltier, fat embolism following intramedullary nailing. Presenting in a wide range of clinical signs of varying severity, fat embolism is usually diagnosed by a physician who keeps a high degree of suspicion. Fat embolism syndrome changing prognosis clarence a. Fat emboli occur in all patients with longbone fractures, but only few of them develop a multisystem disorder affecting the lung, brain, and skin, also known as fat embolism syndrome fes. Pulmonary fat embolism radiology reference article. Fat embolism syndrome develops most commonly after orthopedic injuries, but it has also been reported after other forms of trauma such as severe burns, liver injury, closedchest. But, depending on the risk factors, fes can occur up to 90% in multiple trauma patients and up to 10%.
Role of interleukin6 as an early marker of fat embolism syndrome. It is thought to be caused by deposition of embolic fat within the pulmonary capillaries, resulting in a capillary leak within the lung. Approximately 10 percent of these patients develop clinical findings, collectively known as fat embolism syndrome fes. A 76yrold lady presented for left total knee arthroplasty under general anesthesia.
Based on the clinical presentation and supportive imaging, the patient was diagnosed with fat embolism syndrome. The classical syndrome of fat embolism is characterized by the triad of respiratory failure, neurologic dysfunction and the presence of a petechial rash. The differential diagnosis of fat embolism syndrome includes pulmonary thromboembolism, pulmonary contusion. Caused by fat globules in pulmonary microcirculation. Fat embolism is defined by the presence of fat globules in the pulmonary circulation. Pathophysiology and management of the fat embolism syndrome. Fes is most often associated with orthopedic trauma. May 14, 2018 a fat embolism fe is a piece of intravascular fat that lodges within a blood vessel and causes a blockage of blood flow. This may include a petechial rash, decreased level of consciousness, and shortness of breath. The typical presentation is a triad of hypoxemia, neurologic abnormalities, and petechial rash, although these symptoms do not occur together in all cases.
Fat embolism syndrome renu saigal, m mittal, a kansal, y singh, pr kolar, s jain abstract fat embolism syndrome is a rare complication occurring in 0. Common systemic manifestations include respiratory distress, altered mental status, and a rash. The fat embolism criteria calculator consists of two diagnosis models. Fat embolism syndrome fes occurs most commonly following orthopedic trauma, particularly fractures of the pelvis or long bones, however nontraumatic fat embolism has. Traumatic fat embolism occurs in 90 percent of individuals with severe skeletal injuries, but the clinical presentation is usually mild and goes unrecognized. Fat embolism syndrome is a serious consequence of fat emboli producing a distinct pattern of clinical symptoms and signs. Wilson, belfast, northern ireland fromtheroyal victoria hospital, belfast the fatembolism syndrome, often acomplication ofmajor trauma, frequently passes undiagnosed.
Mar 27, 2020 if it progresses to the rare clinical entity known as fat embolism syndrome fes, a systemic inflammatory cascade affecting multiple organ systems, morbidity and mortality are high. Mar 05, 2019 fat embolism syndrome occurs when embolic fat macroglobules pass into the small vessels of the lung and other sites, producing endothelial damage and resulting respiratory failure acute respiratory distress syndrome ardslike picture, cerebral dysfunction and a petechial rash 2, 3. Cerebral fat embolism syndrome in sickle cell disease. Characteristic imaging findings in pulmonary fat embolism.
Fes refers to clinical syndrome that follows an identifiable insult which releases fat into the circulation, resulting in pulmonary and systemic symptoms. Although its original clinical description dates from 1873,1 fat embolism syndrome. Fat embolism syndrome is an often overlooked cause of breathlessness in trauma wards. The diagnosis of fat embolism is made by clinical features alone with no specific laboratory findings. Fat embolism syndrome fes is an illdefined clinical entity that arises from the systemic manifestations of fat emboli within the microcirculation.
Autopsy diagnosis of fat embolism syndrome request pdf. Fat embolism most commonly occurs as a result of fractures of bones. Fat embolism is the presence of fat particles within the microcirculation, while fes is the systemic manifestation of fat emboli within the microcirculation. Fat embolism syndrome is most often caused by trauma and orthopaedic injuries and is a condition with 15% mortality rates if left untreated. Pathology it usually occurs in the context of a long bone fracture and may occur in % of patients with simple tibial or femor. It is most commonly associated with fractures of long bones and the pelvis, and is more frequent in closed, rather than open, fractures. Fat embolism syndrome international journal of emergency. Although neurologic involvement is common, the pathophysiology of cerebral fat emboli remains controversial. Fes describes a characteristic pattern of clinical findings that follow an insult associated with the release of fat. Fat embolism develops in nearly all patients with bone fractures or during orthopedic procedures. Millers anesthesia, 7th edition, churchill livingstone. Fat emboli usually reach the brain through either righttoleft cardiac shunt or through an intact pulmonary circulation in those without a shunt 3. Fat embolism syndrome is characterized by the onset of respiratory, neurological, cutaneous, and hematologic manifestations and is thought to be related to intravascular embolization of fat, presumably arising from within the fractured bone marrow space. A process by which fat emboli passes into the bloodstream and lodges within a blood vessel.
Although it was observed centuries ago that intravenous injection of oil resulted in mechanical obstruction of small vessels, 1 the exact pathophysiology of fat embolism syndrome fes remains uncertain. Fat embolism syndrome and elective knee arthroplasty. Accordingly, swift diagnosis and treatment of fat embolism are paramount for ensuring the survival of this patient population. This patient showed the classic triad of fes consisting of hypoxemia, neurological abnormalities, and petechial rash. Fat embolism definition of fat embolism by medical dictionary. It has been recognized since the latter part of the 19th c. Fat embolism syndrome occurs when fat enters the blood stream fat embolism and results in symptoms. The fat embolism syndrome is a source of considerable morbidity after blunt trauma and is associated with a mortality of 10 to 20 percent. Commonly associated with orthopedic fractures, especially long bone fractures of lower extremities eg.