Abstract
Fat embolism syndrome (FES) is a constellation of clinical symptoms characterized by a triad of respiratory insufficiency, altered sensorium and petechiae occurring after orthopaedic trauma or following surgical manipulation of long bones and spine. The diagnosis is based on clinical presentation and excluding other possible conditions. Beside histopathology, none of the investigations such as fat macroglobinuria in urine or lipid laden macrophages in bronchoalveolar lavage (BAL) is 100% specific. At times FES can present with atypical presentation such as intra alveolar haemorrhage and only high index of suspicion can help in making diagnosis.
Highlights
Fat embolism occurs when fat globules from the bone marrow enter the circulation mostly after orthopaedic trauma causing fractures of long bones, pelvis or vertebra
Fat embolism syndrome (FES) is a constellation of clinical symptoms characterized by a triad of respiratory insufficiency, altered sensorium and petechiae
At times FES can present with atypical presentation such as intra alveolar haemorrhage as in the case described below and only high index of suspicion can help in making diagnosis
Summary
Fat embolism occurs when fat globules from the bone marrow enter the circulation mostly after orthopaedic trauma causing fractures of long bones, pelvis or vertebra. An initial suspicion of fat embolism syndrome, pulmonary thromboembolism, pulmonary oedema and hospital acquired pneumonia were kept His Chest X-ray taken in emergency showed bilateral infiltrate. An ECG showed normal sinus tachycardia and bedside 2D ECHO was normal He underwent CT pulmonary angiogram that showed bilateral diffuse ground glass opacities with relative pleural sparing and no evidence of pulmonary embolism (figure 1). His urine routine microscopy was normal and no fat globules were identified. In view of sudden fall in haemoglobin, streaky haemoptysis and bilateral lung infiltrate a diffuse alveolar haemorrhage was suspected He was admitted and received broad spectrum antibiotics (Meropenem and Teicoplanin) for MDR bacteria coverage, proton pump inhibitor. On deduction in an appropriate clinical scenario our patient too fits into the clinical criteria of fat embolism syndrome
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