Cases reported "Embolism, Fat"

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1/9. Cerebral fat embolism after a nondisplaced tibial fracture: case report.

    Fat embolism syndrome has been observed after traumatic or nontraumatic events. In traumatic cases, fat embolism syndrome is known to occur in patients with a fracture of a long bone. The case of a patient with a cerebral fat embolism associated with a nondisplaced fracture of the tibial shaft is reported.
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2/9. 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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3/9. Fat embolism syndrome.

    The fat embolism syndrome is clinically evident in approximately 0.5-2.0% of patients with long bone fractures. The clinical signs and symptoms are evident in 60% of patients within 24 hours and 85% of patients within 48 hours after trauma. A patient is reported who complained of dyspnea and hemoptysis approximately 72 hours after sustaining a fracture to the distal tibia and fibula. Radionuclide ventilation/perfusion imaging was obtained to rule out pulmonary thromboemboli. perfusion imaging demonstrated the characteristic diffuse, subsegmental ("mottled") appearance of fatty emboli to the lung.
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4/9. "Matching" ventilation/perfusion images in fat embolization.

    Forty-eight hours after fracture of the tibia and fibula, a 27-year-old man developed the triad of findings noted in the fat embolism syndrome (neurologic changes, respiratory distress, and petechiae). An initially normal chest-x-ray, which progressed to one of bilateral fluffy diffuse infiltrates, aided in making the diagnosis. ventilation/perfusion lung images were performed at the time of the radiographic changes and showed "matching" defects. Transcapillary passage of lipid breakdown products was considered to be the cause. While all parts of the lung showed reduced ventilation/perfusion, the upper half of the lung fields was affected more prominently, as opposed to emboli of venous origin, which most frequently involve the lung bases.
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keywords = tibia
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5/9. Periodic EEG patterns in cerebral fat embolism.

    A 24-year-old male developed fat embolism syndrome (FES) 18 hours after accidental tibial and metatarsal fractures. The onset was characterized by coma, generalized seizures, respiratory distress and hypoxemia. Multiple prolonged portable electroencephalographic (EEG) recordings showed a variety of progressively changing patterns including continuous high amplitude EEG rhythmical synchronous slowing (CHERSS), triphasic waves, bilateral independent periodic lateralized epileptiform discharges (BIPLEDs), frontal intermittent delta activity (FIRDA), and low amplitude irregular generalized theta. Three months after the accident, the patient was neurologically normal and his EEG exhibited only rare brief bursts of anterior theta in the waking recording. I conclude that EEG periodic activity such as CHERSS, triphasic waves, BIPLEDs, and FIRDA can occur in patients suffering from cerebral fat embolism. It reflects a non-specific diffuse encephalopathy not necessarily associated with a poor prognosis. Prolonged and frequent bedside EEG recordings will demonstrate better these fluctuating abnormalities in cerebral fat embolism (and probably in coma of other origin) than standard less frequent recordings. Very likely, these periodic EEG patterns have not been previously identified in cerebral fat embolism because they were not in vogue among electroencephalographers nor widely accepted at the time studies dealing with this syndrome were written.
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keywords = tibia
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6/9. Fat embolism in children.

    Clinical fat embolism in children is rare. An 11-year-old myelodysplastic child with an apparently insignificant tibial fracture illustrates the risk of this potentially fatal complication in children with osteoporotic bone.
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7/9. Fatal cerebral fat embolism associated with a patent foramen ovale.

    A healthy 22-year-old woman developed respiratory failure and brain death within 48 h of bilateral tibial fractures. autopsy showed fat embolism in the lung and brain, and a large patent foramen ovale that may have contributed to massive cerebral fat embolism.
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8/9. Combined fractures of the femoral and tibial shafts in the same limb.

    This paper reports a study of ipsilateral fractures of the femoral and tibial shafts in 21 patients treated according to a detailed plan including shock treatment, prophylaxis against fat embolism, soft-tissue and fracture treatment. Death due to hypovalaemic shock was eliminated and the incidence of fat emboliism (9-5%) reduced in comparison with an earlier series. The tibial fracture was stabilized by plaster or internal fixation as soon as conditions allowed. In most cases the femoral fracture was treated by medullary mailing. Results have improved compared with earlier series. All fractures healed within 15 months, and functional end results have been excellent in the majority of the surviving patients (89%).
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keywords = tibia
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9/9. Massive fat emboli syndrome after unsuccessful unreamed nailing of the tibia.

    A patient is presented in whom massive fat emboli syndrome (FES) developed after the unsuccessful treatment of a solitary tibial fracture with an unreamed tibial nail. Ultimately, a reamed tibial nail was inserted. Several risk factors for the development of FES were identified retrospectively in this particular case: a very small medullary canal, a large-diameter unreamed tibial nail, reaming of a small medullary canal and insertion of a thick reamed tibial nail. Even in the presence of patients with solitary lesions and without obvious risks for FES, one should always take this dangerous complication into account.
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keywords = tibia
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