1/192. Two episodes of clinical fat embolism following multiple fractures. Second episodes of clinical fat embolism have not previously been reported. This paper presents the case report of a patient with multiple fractures who developed two distinct attacks with a symptom-free interval. The second attack was partly responsible for death, and histological examination confirmed the diagnosis. ( info) |
| Fat embolism from the grossly fatty liver of an infant with kwashiorkor is described. Globules of fat were seen at necropsy in the hepatic veins, in the right atrium and ventricle of the heart and in the pulmonary artery. Sections of the lung showed fat emboli in numerous branches of the pulmonary artery. Examination of lung sections taken at necropsy from 40 patients who had severe kwashiorkor failed to show similar fat embolism. ( info) |
| We report an unusual lethal complication of sickle cell anemia. The patient was admitted with a diagnosis of acute chest syndrome and died shortly after that of respiratory failure. autopsy revealed numerous deposits of bone marrow hematopoietic tissue occluding the microvascular circulation of the lung. Many causes of acute chest syndrome in sickle cell anemia have been identified, including bone marrow infarction leading to embolism of bone marrow fat. However, the release of bone marrow hematopoietic tissue leading to pulmonary vascular occlusion is not generally recognized premortem by treating physicians. ( info) |
4/192. Fat embolism syndrome in a case of abdominal lipectomy with liposuction. Fat embolism syndrome is reported in a patient who underwent abdominoplasty and suction lipectomy for body contouring. Within 48 hours after surgery, she experienced adult respiratory distress syndrome, secondary to fat embolism syndrome. This was proven on bronchoscopy by evidence of fat laden macrophages. Aggressive respiratory support over 12 days resulted in patient survival. ( info) |
5/192. Unusual finding after contrast injection of a solitary bone cyst. A case report. Injection of radiopaque contrast into a solitary bone cyst (SBC) prior to methylprednisolone acetate (MPA) injection has been previously reported. We report an unusual finding during the injection of radiopaque contrast in the treatment of one case of SBC of the femur: a bicameral appearance of the cyst was observed; no filling of the proximal cavity occurred and immediate perfusion of the femoral vein with contrast was noted. In cases of SBC such as this one, percutaneous autologous marrow or corticosteroid injection may fail to be effective. Furthermore there exists the potential risk of fat embolus secondary to bone marrow injection. Based on these findings in the case reported, we suggest that contrast injection should be performed prior to bone marrow or corticosteroid injection in order to evaluate both the venous drainage of the cyst and its degree of loculation. ( info) |
6/192. Pulmonary fat embolism: a complication of fracture. Medical personnel must be aware of the possibility of fat embolism as a complicating factor of fractures. Ambulance, emergency room, orthopedic, and intensive-care personnel may frequently be involved in the care of these patients. Fat embolism should be suspected any time a patient exhibits bizarre mental, pulmonary, or circulatory symptoms following a fracture. Prevention may be achieved by as near immobilization of a fracture as possible. When fat embolism does occur, the course of the illness may or may not be complex. The treatment is supportive and the patient should be made as comfortable as possible. ( info) |
7/192. Transcranial doppler detection of fat emboli. BACKGROUND AND PURPOSE: The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler. methods: Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small. RESULTS: Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale. CONCLUSIONS: Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications. ( info) |
8/192. Pulmonary nodules in early fat embolism syndrome: a case report. The radiologic abnormalities in a patient with mild clinical manifestations of fat embolism are reported. The findings consisted of small nodular opacities, which were shown on computed tomography (CT) scans to be located predominantly in the centrilobular and subpleural regions. The nodules presumably represented alveolar edema or hemorrhage secondary to the fat embolism syndrome. ( info) |
9/192. Prolonged coma due to cerebral fat embolism: report of two cases. Fat embolism syndrome remains a rare, but potentially life threatening complication of long bone fractures. The true incidence is difficult to assess as many cases remain undiagnosed. Cerebral involvement varies from confusion to encephalopathy with coma and seizures. Clinical symptoms and computed tomography are not always diagnostic, while magnetic resonance imaging is more sensitive in the detection of a suspected brain embolism. Two cases of post-traumatic cerebral fat embolism, manifested by prolonged coma and diffuse cerebral oedema, are presented. The clinical course of the disease as well as the intensive care unit management are discussed. ( info) |
10/192. coma from fat embolism syndrome after hemiarthroplasty of the hip for metastatic breast cancer to the proximal femur: a case report. We present a case report of fat embolism syndrome (FES) that resulted in prolonged coma after cemented hemiarthroplasty in a patient with metastatic breast cancer. After the cemented hip prosthesis was placed, the patient developed decreased sensorium that progressed to coma in association with hypoxemia and tachypnea. Pulmonary compromise was mild, and the patient required only supplemental oxygen for support. The patient demonstrated no petechiae. Magnetic imaging results were consistent with FES. While the pulmonary symptoms resolved quickly, the patient remained unresponsive for 11 days without purposeful motor function. After waking she recovered rapidly, and at her 2-month follow-up appointment, demonstrated no adverse orthopedic, pulmonary, or neurologic sequelae. ( info) |