Cases reported "Embolism, Fat"

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11/47. Paradoxical fat embolism after intramedullary rodding: a case report.

    Following intramedullary rodding of two long-bone fractures, a twenty-year-old woman developed the clinical picture of fat embolism syndrome with severe neurological involvement. Corroborating evidence suggested paradoxical embolization of fat as the precipitating cause of this neurologic deterioration. The suspected pathophysiology of this event is discussed.
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keywords = fracture
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12/47. Serial analysis of fat-containing macrophages in bronchoalveolar lavage fluid in a patient with fat embolism syndrome.

    Recent studies suggest that an increase in fat-containing macrophages in bronchoalveolar lavage (BAL) fluid may be helpful in the diagnosis of fat embolism syndrome (FES). Nevertheless, none of these studies have explored the sequential findings of BAL fluid. We report the case of a 19-year-old man admitted to our intensive care unit because of dyspnea with radiographic evidence of bilateral alveolar infiltrate after traumatic fracture. Analysis of BAL fluid on the third hospital day revealed 8.3% fat-containing macrophages and a lipid-laden macrophages (LLM) index of 23. Pathologic examination of lung biopsy showed numerous fat globules within arterioles. For comparison, the BAL fluid from four other patients with acute respiratory distress syndrome (ARDS) but without FES was also analyzed. The underlying diseases leading to ARDS included Wegener's granulomatosis in one case, pneumonia in two cases, and alveolar proteinosis in one case. The percentages of fat-containing macrophages in these specimens were 1.3%, 52%, 2.3%, and 74%, respectively. The LLM indexes were 1, 133, 3, and 243, respectively. As the patient's condition improved, the percentage of fat-containing macrophages in the BAL fluid decreased to 4.7% on the eighth hospital day and the LLM index also decreased to 6. These findings suggest that the presence of fat-containing macrophages in BAL fluid is not specific for the diagnosis of FES, but serial changes in the percentage of these cells and the LLM index may be helpful in the follow-up of disease severity.
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keywords = fracture
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13/47. early diagnosis of cerebral fat embolism syndrome by diffusion-weighted MRI (starfield pattern).

    BACKGROUND: Cerebral fat embolism syndrome is a rare, but potentially lethal, complication of long bone fractures. Neurological symptoms are variable, and the clinical diagnosis is difficult. The purpose of this case study is to demonstrate the value of diffusion-weighted MRI of the brain for early diagnosis of fat embolism syndrome. Case Description- A non-head-injured 18-year-old woman suffered acute mental status changes 21 hours after an uncomplicated fracture of the left tibia. MRI of the brain was performed 48 hours after injury. T2-weighted images showed multiple nonconfluent areas of high signal intensity, which, on the diffusion-weighted scans, were revealed as bright spots on a dark background ("starfield" pattern). We suggest that this indicates areas of restricted diffusion that are due to cytotoxic edema, resulting from multiple microemboli. CONCLUSIONS: High-intensity lesions in the brain on diffusion-weighted images may serve as an early-appearing and more sensitive indicator of the diagnosis of fat embolism in the clinical context of long bone injury without head trauma.
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ranking = 2
keywords = fracture
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14/47. Endovascular closure of a patent foramen ovale in the fat embolism syndrome: changes in the embolic patterns as detected by transcranial Doppler.

    BACKGROUND: The posttraumatic fat embolism syndrome (FES) is characterized by petechiae and pulmonary and cerebral dysfunction. A patent foramen ovale (PFO) could worsen the prognosis of FES by allowing larger emboli to reach the systemic circulation. Transcranial Doppler ultrasonography can be used to diagnose and monitor cerebral microembolism in FES. OBJECTIVE: To describe a case of successful percutaneous closure of PFO in a patient with posttraumatic FES with excellent clinical outcome. PATIENT AND methods: A 17-year-old girl presented with a posttraumatic long-bone fracture complicated by typical severe FES. Transcranial Doppler disclosed multiple microembolic signals over both middle cerebral and basilar arteries. A large PFO was diagnosed by transesophageal echocardiogram. A brain magnetic resonance image with diffusion-weighted sequences showed multiple bilateral areas of abnormal diffusion in watershed territories. Percutaneous PFO closure with a buttoned device was successfully performed. RESULTS: Closure of PFO was associated with marked reduction in the number and intensity of microembolic signals. Subsequent surgical repair of the fracture with the patient under transcranial Doppler monitoring was uneventful. There was excellent correlation between clinical course and microembolic signal load by transcranial Doppler. CONCLUSIONS: Cerebral fat embolism after long-bone fractures can be detected in vivo and monitored over time with the use of transcranial Doppler techniques. If a PFO is present, its closure before surgical manipulation of the fracture is feasible and could have important protective effects against massive systemic embolization.
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ranking = 4
keywords = fracture
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15/47. Fat embolism associated with an atrial septal defect.

    A case of a patient with pulmonary fat embolism following fractures of femurs and pelvis, with a fatal outcome after 3 days, is presented. Post mortem examination revealed a congenital osteum secundum heart defect, and widespread capillary occlusions from systemic fat microembolization.
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keywords = fracture
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16/47. Traumatic fat embolism syndrome.

    Traumatic fat embolism syndrome occurs most often following fractures of long bones sustained in road traffic accidents and is a common cause of medical consultation from the orthopedic surgery department. The sub-clinical presentation is subtle and expresses itself by the presence of hypoxemia, while the full clinical syndrome compromises respiratory insufficiency, an altered consciousness and a characteristic petechial rash. Recognition is simple once the patient is viewed in the context of his or her clinical setting. Diagnosis is aided further by the presence of hematological and biochemical abnormalities including anemia, thrombocytopenia, an elevated erythrocyte sedimentation rate and fat macroglobulinemia. Imaging by chest radiograph, computed tomography or magnetic resonance of the brain is used to confirm the extent of the respective organ involvement and to exclude alternative pathologies. The release of free fatty acids into the circulation and their subsequent effects is the key pathological event. Treatment is based on supportive care and high-dose corticosteroid therapy. We report a patient with traumatic fat embolism syndrome who developed the syndromes classical symptoms and signs following fracture of the long bones of his left lower leg. Admission to an intensive care unit, mechanical ventilatory support with positive end-expiratory pressure and corticosteroid therapy lead to his improvement and allowed eventual open reduction and internal fixation and discharge of our patient. Modern therapy offers a relatively good prognosis for patients with traumatic fat embolism syndrome; the optimal dose and timing of corticosteroid therapy in prophylaxis and treatment however, remain the subject of intense debate.
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ranking = 2
keywords = fracture
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17/47. femur fractures: complications & treatments of traumatic femoral shaft fractures.

    Femoral shaft fractures can present many challenges to health-care providers from the time of injury to the time of discharge and beyond. Ongoing assessment and definitive interventions prove successful in limiting additional morbidity and mortality.
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ranking = 9
keywords = fracture
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18/47. Cerebral fat embolism diagnosed by magnetic resonance imaging at one, eight, and 50 days after hip arthroplasty: a case report.

    PURPOSE: To describe cardiovascular collapse during a cemented hip hemiarthroplasty in a patient who, despite a successful cardiopulmonary resuscitation, remained in a persistent vegetative state due to cerebral fat embolism diagnosed by magnetic resonance imaging (MRI). CLINICAL FEATURES: A 75-yr-old woman with no medical history underwent cemented hip hemiarthroplasty under spinal anesthesia for a right femoral neck fracture. Shortly after insertion of the prosthesis, a sudden oxygen desaturation, hypotension, bradycardia, and cardiac arrest occurred. The patient was successfully resuscitated, but did not regain consciousness. The patient developed high-grade fever, thrombocytopenia, anemia, and oliguria. MRI scans of the brain revealed multiple high intensity signals throughout the white matter, the basal ganglia, the cerebellum, and the brain stem. The diagnosis of fat embolism was made on the basis of clinical findings and MRI images. Although her cardiorespiratory status improved over the next week, the patient remained in a persistent vegetative state. CONCLUSION: When fat embolism is suspected, serial MRI scans of the brain should be performed to diagnose the etiology of cerebral embolism as well as to evaluate the severity of brain damage.
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ranking = 1
keywords = fracture
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19/47. Resuscitation of fat embolism syndrome with extracorporeal membrane oxygenation.

    Embolization of marrow fat appears to be an inevitable consequence of long bone fractures. Pulmonary fat embolism (FE) with cardiovascular collapse is associated with a high mortality rate because of acute right ventricular failure and hypoxia. Immediate and appropriate resuscitation is required to prevent sudden death. Although extracorporeal membrane oxygenation (ECMO) has been used for a multitude of applications involving respiratory and circulatory collapse, its full potential as a standard conventional therapy has yet to be exploited. Herein, we describe the successful use of veno-venous (V-V) ECMO in a trauma patient who initially presented with fractures of the right ulna and femur. After surgery, the patient rapidly decompensated despite massive ventilatory support and was placed on ECMO. ECMO support lasted approximately 120 hours followed by an uneventful recovery and discharge 10 days later.
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ranking = 2
keywords = fracture
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20/47. A coronary artery crossed embolism of bone-marrow origin: proof of connections between pulmonary arteries and veins.

    The paper describes a case of exceptionally rare crossed embolism of the coronary artery. The embolus material originated in bone-marrow released from rib fractures which occurred during resuscitation attempts. autopsy did not reveal any anatomical abnormalities of the circulatory system, nor any disease-related changes, which could explain the occurrence of this embolism type, and therefore the only possible explanation is the presence of direct connections between pulmonary arteries and veins. The confirmation of this theory is the bone-marrow embolism of the pulmonary vein detected in the second case.
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keywords = fracture
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