Some authors suggest increasing the cutoff to 30% to improve specificity. Fat embolism has been associated with many nontraumatic disorders. Fat embolism has been described1 as a condition in which fat is circulating in the blood stream in globules large enough to occlude the capillaries and induce multiple anoxic foci. Fat embolism syndrome fes is an illdefined clinical entity that arises from the systemic manifestations of fat emboli within the microcirculation.
Compartment syndrome overview signs and symptoms, pathophysiology, treatment duration. Pulmonary fat embolism is a specific subtype of pulmonary embolism where the embolic particles are composed of fat. Incidence fat embolism syndrome fes most commonly is. Fat emboli commonly occur after fractures to the long bones of the lower body, particularly the femur thighbone, tibia shinbone, and pelvis.
Fat embolism mellor 2001 anaesthesia wiley online library. 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. Fat embolism syndrome is a serious consequence of fat emboli producing a distinct pattern of clinical symptoms and signs. The true incidence is difficult to assess as many cases remain undiagnosed. Pulmonary fat embolism radiology reference article. 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. The four most common embolism seen in the critical care patient population are air embolism, fat embolism, cholesterol embolism, and blood embolism clots embolism is an uncommon complication of altered mentation after invasive procedures, but it must be placed on the list of differential diagnoses. Prophylactic steroid therapy may be considered for patients at a high risk. Fat embolism fe is defined by the presence of fat globules in the pulmonary microcirculation regardless of clinical significance. Treatment is only supportive, directed mainly at maintaining. It is most common after skeletal injury, and is most likely to occur in patients with multiple long bone and pelvic fractures. The syndrome is largely self limiting with treatment being symptomatic.
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. Pdf the cause of death in fat embolism researchgate. Although its original clinical description dates from 1873, fat embolism syndrome remains a diagnostic challenge for clinicians. A fat embolism is a glob of fat that gets into the bloodstream. When the fat hits the brainsalvage stamca bypass for an. Diagnosis and treatment of fat embolism jama jama network. The reported incidence varies greatly in the literature depending on diagnostic criteria. Fat embolism syndrome is a rare complication occurring in 0.
Immobilization of longbone fractures and management of respiratory distress syndrome are appropriate. Fat emboli occur in all patients with longbone fractures, but only few patients develop systemic dysfunction, particularly the triad of skin, brain, and lung dysfunction known as. The fat embolism syndrome fes is defined as the occurrence of injury and dysfunction of one or more organs, caused by fat emboli, that is, this is. The authors describe the case of a patient who became deeply comatose and ultimately died after a traffic. Fat embolism syndrome is an often overlooked cause of breathlessness in trauma wards. Trauma to soft tissues, including crush injuries, is associated with mul tiple fat emboli. This may include a petechial rash, decreased level of consciousness, and shortness of breath. Fat embolism syndrome remains a rare, but potentially life threatening complication of long bone fractures. The release of fat and bone marrow fragments is a common occurrence following traumatic and nontraumatic events. Fat embolism syndrome is a serious manifestation of fat embolism phenomenon characterized clinically by triad of dyspnoea, petechiae and mental confusion. Summary of symptoms and treatment in the intensive care unit. As the former can occur without the latter, it is sensible to define each entity, acknowledging that there may be some overlap in clinical practice. The fat embolism syndrome fes is defined as the occurrence of injury and dysfunction of one or more organs, caused by fat emboli, that is, this is a complication or a nontypical evolution of fe. Fat embolism syndrome fes is a rare clinical syndrome that can complicate a wide variety of clinical conditions, particularly those where fat is manipulated.
Fes fat embolism syndrome, fis fracture index score, hrct highresolution ct, pfes pulmonary fat embolism syndrome fat embolism occurs in nearly all patients 90% with bone fractures during orthopedic prosthesis procedures and rarely in other pathologic conditions. With a better understanding of the underlying pathophysiological mechanisms, treatment has become more specific and less empirical. Fes is most often associated with orthopedic trauma. Fat embolism is the presence of fat particles within the microcirculation, while fes is the systemic manifestation of fat emboli within the microcirculation. Massive cerebral involvement in fat embolism syndrome and intracranial pressure management. Treatment of fat embolism syndrome is supportive with early resucitation and stabalization to minimize the stress response to hypoxemia, hypotension, and diminished endorgan perfusion.
Although this disease is considered something of a rarity, scuderi2 in 1941 stated that. It may also arise in the postoperative period of orthopedic surgeries or procedures such as liposuction. Common systemic manifestations include respiratory distress, altered mental status, and a rash. In general, an embolus is something that travels through the bloodstream, lodges in a blood vessel, and blocks it. The fat embolism syndrome fes is a rare clinical condition in which circulating fat emboli or fat macroglobules lead to multisystem dysfunction. Fes has no specific treatment and requires supportive care, although it can be prevented by early fixation of bone fractures. Approximately 10 percent of these patients develop clinical findings, collectively known as fat embolism syndrome fes. Pathogenesis, diagnosis and treatment of cerebral fat embolism. Fat embolism definition of fat embolism by medical dictionary. Fat embolism, fat embolism syndrome, fulminant fat embolism syndrome, nitric oxide, corticosteroids fat embolism may be defined as a blockage of blood vessels by intravascular fat globules ranging from 1040 m in diameter. In 1862, zenker first described this syndrome at autopsy.
Fat embolism syndrome fes is a rare but potentially fatal complication of. Fat embolism is common in trauma victims and surgery patients, primarily to the lower extremities. The retinal manifestations of fat embolism sciencedirect. Treatment supportive, steroids dont currently have a role in treatment conflicting data. Fat embolism occurs in all patients with longbone fractures after intramedullary nailing. Emergency management of fat embolism syndrome ncbi. Fat embolism is a wellknown complication of long bone and pelvic fractures. The diagnosis of fat embolism is made by clinical features alone with no specific laboratory findings. The term fat embolism syndrome fes refers to the clinical syndrome that follows an identifiable insult which releases fat into the circulation, resulting in pulmonary and systemic symptoms. Presently, using bal to aid in the diagnosis or to predict the likelihood of fat embolism syndrome is controversial. The term fat embolism indicates the often asymptomatic presence of fat globules in the lung parenchyma and peripheral circulation after long bone or other major trauma. Apr 29, 2018 fat embolism syndrome fes is a lifethreatening complication in patients with orthopedic trauma, especially long bone fractures. In one study, the presence of fat was demonstrated in. In most cases, they go symptomless or cause only minor disturbances, but occasionally they can determine a multiorgan dysfunction whose severity ranges from mild to fatal.
Therapy is directed at maintaining respiratory function and largely follows the same. Cerebral fat embolism cfe is the deposition of lipid droplets or fatty tissue in the cerebral blood circulation. Isolated cerebral fat embolism after hip surgery in the presence of a patent. It takes place when fat from the bone marrow dislodges and enters the bloodstream, where it forms what is known as emboli, a small collection of fat cells, where it then becomes embedded in the blood vessel wall, blocking the blood flow. The cause of death in the fat embolism syndrome can be attributed either to pulmonary or cerebral. Fat embolism syndrome is a rare condition that can develop after trauma injury or surgery to the legs. Emergency management of fat embolism syndrome shaikh n j. Fes describes a characteristic pattern of clinical findings that follow an insult associated with the release of fat into the circulation. Recommendations are made as to several tests for the early detection of the fat embolism syndrome. A fat embolism fe is a piece of intravascular fat that lodges within a blood vessel and causes a blockage of blood flow.
Fat emboli occur in all patients with longbone fractures, but only few patients develop systemic dysfunction. Mimoz o, edouard a, beydon l, quillard j, verra f, fleury j. Although this disease is considered something of a rarity, scuderi2 in 1941 stated that there were over 600 references. Patients with fractures involving the middle and proximal parts of the femoral shaft are more likely to experience fat embolism. 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. It is a common misconception that the presence of fat globules, either in sputum, urine, or a wedged pa catheter, is necessary to confirm the diagnosis of fes. It is problematic when the glob is too large to pass through a blood vessel, causing it to get stuck. 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.
Contribution of bronchoalveolar lavage to the diagnosis of posttraumatic pulmonary fat embolism. Pathology it usually occurs in the context of a long bone fracture and may occur in % of patients with simple tibial or femor. Mar 27, 2020 mimoz o, edouard a, beydon l, quillard j, verra f, fleury j. Fat embolism describes both fat in the circulation and a clinical syndrome. Introduction the classical syndrome of fat embolism is characterized by the triad of respiratory failure, neurologic dysfunction and the presence of a petechial rash 1,2. Fat embolism is the obstruction of blood vessels by fat droplets that most often happens after fractures of long bones, such as bones of the legs, thighs or hips. Many aspects of the fat embolism syndrome remain poorly understood, and disagreement about its etiology, pathophysiology, diagnosis and treatment persists. Highresolution ct findings in mild pulmonary fat embolism. Mar 27, 2020 accordingly, swift diagnosis and treatment of fat embolism are paramount for ensuring the survival of this patient population. Fat emboli occur in all patients with longbone fractures, but only few patients develop systemic dysfunction, particularly the triad of skin, brain, and lung dysfunction known as the fat embolism syndrome fes. Current treatments are supportive and the condition is usually associated with a good outcome. Cerebral involvement varies from confusion to encephalopathy with coma and seizures. A good number of articles on its prevention during gluteal fat grafting are available in the literature. A fat embolus is a fat particle or droplet that travels through the circulation and eventually blocks a blood vessel.
However, the recovery of fat globules is of uncertain significance. The majority 95% of cases occur after major trauma. Fat embolism is defined by the presence of fat globules in the pulmonary circulation. Almost all cases of fes are due to long bone and pelvic fractures bone marrow contains a high content of fat. Highdose rosuvastatin treatment for multifocal stroke in traumainduced cerebral fat embolism syndrome. A process by which fat tissue passes into the bloodstream and lodges within a blood vessel. Clinical symptoms and computed tomography are not always diagnostic, while magnetic resonance imaging is more sensitive in the. There are currently no diseasespecific treatments for fes. It is therefore difficult to determine the incidence of this complication. Shier mr, wilson rf, james re, riddle j, mammen ef, pedersen he.
Adams department of neurological surgery, the radcliffe infirmary, oxford a case of fat embolism is described, emphasizing the mild and possibly transient confusion that precedes the onset of coma. Systemic fat embolism produces a clinical syndrome with characteristic findings and pertinent laboratory results. 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, brain, and skin, in which case the term fat embolism syndrome fes is reserved. Ocurrs in 10% of multiple trauma patients and 3% of single bone fractures 10% mortality theories the pathogenesis of the fat embolism syndrome is the subject of conjecture and controversy bone marrow or fragments have been demonstrated in lung sections, i. Traumatic fat embolism occurs in 90 percent of individuals with severe skeletal injuries, but the clinical presentation is usually mild and goes unrecognized. It ranges from less than 2% to 22% in different studies. Fes refers to clinical syndrome that follows an identifiable insult which releases fat into the circulation, resulting in pulmonary and systemic symptoms.