Diagnosis Of Fat Embolism Syndrome Research Articles

The study of diagnostic test of using the ten-point scale for the early fat embolism syndrome

Objective To explore the clinical value of the ten-point scale in the early diagnosis of fat embolism syndrome.Methods The data of 129 patients with fat embolism syndrome diagnosed by Gurd criteria admitted from January 1993 to February 2012 were analyzed retrospectively.At the same time,another 97 patients with single or multiple long bone fracture and/or pelvic fracture without fat embolism admitted from July 2005 to February 2012 were enrolled as control group.Patients were excluded if they had any of the following diseases:simple brain trauma,thoracic injury,spine fracture,hemorrhagic shock and the complications of cardiopulmonary cerebral resuscitation (CPCR).The patients of two groups were comparable in respect of clinical setting.The clinical data were analyzed and scored by the ten-point scale.The x2 test were applied to statistical works.Results Among all the clinical characteristics,the incidence of increased D-dimer was the highest (74.1％) in early fat embolism syndrome,followed by the progressive decrease in hemoglobin (63.6％) and hypoxemia (57.4％),and the occurrence of dyspnea was the lowest (17.8％).The percentage of total scores over ten points in patients with fat embolism syndrome group was higher than that in those without fat embolism syndrome (x2 =202.6,P ＜ 0.01).The sensitivity of tenpoint scale was 96.12％ and the specificity was 99.8％.Conclusions Ten-point scale could be used to make early diagnosis of fat embolism syndrome,thereby reducing the occurrence of misdiagnosis and misseddiagnosis. Key words: Ten-point scale; Fat embolism syndrome; Early diagnosis; Differential diagnosis

Fat embolism syndrome.

Fat embolism syndrome is an often overlooked cause of breathlessness in trauma wards. 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. The clinical background, chronology of symptoms and corroborative laboratory findings are instrumental in a diagnosis of fat embolism syndrome. There are a few diagnostic criteria which are helpful in making a diagnosis of fat embolism syndrome. Management is mainly prevention of fat embolism syndrome, and organ supportive care. Except in fulminant fat embolism syndrome, the prognosis is usually good.

A case of fat embolism syndrome in juvenile rheumatoid arthritis patient

Fat embolism syndrome is a serious complication that can occur after trauma or operation of the limbs. Clinical criteria are used for the diagnosis of fat embolism syndrome and sometimes radiologic findings are helpful. Fat embolism syndrome is known to occur less frequently in children than in adults, but there is an increased risk in children with connective tissue disease. However, there are only a few reported cases of fat embolism syndrome in juvenile rheumatoid arthritis which is the most common connective tissue disease in children. We report a case of fat embolism syndrome diagnosed in a 13-year-old boy with juvenile rheumatoid arthritis, which was treated with corticosteroid. (�������� ������ ������ ����(���������������

Pulmonary and Cerebral Fat Embolism Syndrome After Total Knee Replacement

Fat embolism occurs after long bone fracture or orthopedic surgery and usually shows mild symptom. But it rarely results in fat embolism syndrome, presenting as multiorgan dysfunction such as lung, brain and skin. Although the diagnosis of fat embolism syndrome is mostly based on clinical features, we experienced fat embolism syndrome involving lung and brain, showing typical imaging findings in pulmonary computed tomography and brain magnetic resonance image. So we present interesting case about fat embolism syndrome after total knee replacement with reviewing associated literatures including imaging findings.

Fat embolism syndrome: What have we learned over the years?

Although its original clinical description dates from the nineteenth century, fat embolism syndrome remains a diagnostic challenge for clinicians. Fat emboli occur in all patients with long-bone fractures, but only few of them develop a multisystem disorder affecting the lung, brain, and skin, also known as fat embolism syndrome (FES). The incidence of FES varies and is often underestimated. Mechanical and biochemical theories have been proposed for the pathophysiology of FES. Clinical manifestations consist of respiratory and cerebral dysfunction and a petechial rash. Diagnosis of FES is difficult and based mainly on clinical criteria. FES is a self-limiting disease and treatment needs to be mainly supportive. Surgical treatment of the coexistent injuries is still obscured by controversies and the treatment methods used provide inconclusive results. In this context, prevention focuses on the early identification of predisposing factors.

特発性間質性肺炎の治療中に,左大腿骨頸部骨折を契機に急激な呼吸不全を呈した脂肪塞栓症候群の1例

A 78 year old Japanese woman was transferred to our hospital for the treatment of a fracture of the left femoral neck in April, 2010. She had been taking oral corticosteroid (prednisolone 5 mg/day) for the treatment of idiopathic interstitial pneumonia since 2003, and had been treated by home oxygen therapy since 2007. She fell in the restroom at home and hurt herself, and was transferred to our hospital for treatment of a left femoral neck fracture in April, 2010. Her respiratory status was stable just after the transfer; however, she was transferred to the intensive care unit and started to receive mechanical ventilation due to rapidly progressive respiratory failure on the fourth day after admission. Chest X-ray and computed tomography revealed rapid progression of bilateral ground-glass attenuations, and acute exacerbation of interstitial pneumonia was clinically suspected. However, the elevation of D-dimer over time and characteristic findings of petechial hemorrhagic lesions on her palpebral conjunctivae and neck with microscopic findings of phagocytized lipid in alveolar macrophages in her endobronchial secretion led to the diagnosis of fat embolism syndrome. She was successfully treated with high-dose corticosteroid and sivelestat sodium, and she was discharged on the 21st day after admission. Although a differential diagnosis of acute exacerbation of interstitial pneumonia and fat embolism syndrome was necessary and difficult in the present case, characteristic findings of petechial hemorrhagic lesions of skin, palpebral conjunctiva and lipid-laden alveolar macrophages in endotracheal aspirate were useful for the accurate and prompt diagnosis of fat embolism syndrome.

Analyzing fat embolism syndrome in trauma patients at AIIMS Apex Trauma Center, New Delhi, India.

Background:Fat embolism syndrome (FES) is a constellation of symptoms and signs subsequent to orthopedic trauma.Materials and Methods:The clinical profile of FES in the trauma population was studied over 2 years and 8 months.Results:The incidence of FES among all patients with long bone and pelvic fractures was 0.7% (12). The mean injury severity score was 10.37 (SD 1.69) (range 9-14). The diagnosis of FES was made by clinical and laboratory criteria. Hypoxia was the commonest presentation (92%). The average days of onset of symptoms were 3.5 (SD1.29) days. Management included ventilator support in 75%, average ventilator days being 7.8 (SD 4.08) days. The average ICU stay and hospital stay were 9.1 days and 29.7 days, respectively. A mortality of 8.3% (1) was observed.Conclusion:Fat embolism remains a diagnosis of exclusion and is a clinical dilemma. Clinically apparent FES is unusual and needs high index of suspicion, especially in long bone and pelvic fractures.

Cerebral fat embolism without intracardiac shunt: A novel presentation

Fat embolism syndrome (FES) is defined as an uncommon life-threatening disease process consisting of pulmonary, central nervous system (CNS), and cutaneous manifestations. The pathophysiology of this secondary injury is poorly understood. In the setting of the multiply injured patient, the diagnosis of FES is difficult to ascertain. A case report of a posttraumatic death caused by acute dissemination of diffuse fat emboli to the brain and lungs in the absence of a right-to-left heart defect after femur fracture is presented. The transesophageal echo cardiogram with bubble study failed to demonstrate an intracardiac defect or AV malformation in the lung further supporting a biochemical process. The acute decompensation of the patient within 2 h of the injury would favor mechanical emboli. Supportive care continues to be the mainstay of treatment for FES. Cerebral fat embolism should be considered in traumatically injured patients with unexplained decline in their neurologic examination. Cerebral fat embolism may occur without an intracardiac shunt.

CD61 and fibrinogen immunohistochemical study to improve the post-mortem diagnosis in a fat embolism syndrome clinically demonstrated by transesophageal echocardiography

Fat embolization following major trauma is reported to be a quite common event, while the clinical fat embolism syndrome (FES) seems to be a much rarer event. Fat embolism occurs in 2 up to 23% of patients with isolated femoral shaft fractures. This complication appears to be related not only to the fracture, but also to the timing of stabilization. Sometimes it may be impossible to perform histochemical reactions on frozen sections to detect fat emboli thus confirming diagnosis or suspicion of FES. The finding of fibrinogen and platelets around the apparently empty spaces in the blood vessels has been proposed as an evidence for vital reaction due to either a vital cellular reaction or a flotation mechanism, thus supporting an intravital fat embolism. We report a fatal case due to fat embolism syndrome in a young man hospitalized for a right femoral neck fracture, treated with orthopaedic surgery and subjected to an intra-surgery transesophageal echocardiography that revealed embolization of numerous highly echogenic bodies. Four hours after the onset of clinical symptoms the man died from respiratory failure. The autopsy confirmed the clinical diagnosis of fat embolism syndrome. The histological examination revealed a large amount of fat globules in cerebral and pulmonary arteries and in glomerular capillaries, as well as fibrin and platelet deposition confirmed by the positive results by Sudan III staining for lipids and immunohistochemistry with anti-CD61 and anti-fibrinogen antibodies. The quantitative classification of fat embolism was grade 3 of Sevitt's classification or grade 4 of Fineschi's quantification, according to the current quantitative microscopic methods used for grading fat embolism in pulmonary tissue.

Fat Embolism Syndrome Secondary to Injection of Large Amounts of Soft Tissue Filler in the Gluteal Area

There are no reports in the literature of an association between soft tissue filler (STF) injection and fat embolism syndrome (FES). The authors present the case of a 26-year-old woman who was injected in the gluteal area with approximately 200 cc of STF on each side for aesthetic purposes. After this procedure, she presented with the triad of hypoxemia, neurological impairment, and petechiae consistent with the diagnosis of FES. After advanced support measures, she recovered completely. This article reviews the presence of FES after a cosmetic procedure with STF.

Emergency management of fat embolism syndrome.

Fat emboli occur in all patients with long-bone fractures, but only few patients develop systemic dysfunction, particularly the triad of skin, brain, and lung dysfunction known as the fat embolism syndrome (FES). Here we review the FES literature under different subheadings.The incidence of FES varies from 1–29%. The etiology may be traumatic or, rarely, nontraumatic. Various factors increase the incidence of FES. Mechanical and biochemical theories have been proposed for the pathophysiology of FES. The clinical manifestations include respiratory and cerebral dysfunction and a petechial rash. Diagnosis of FES is difficult. The other causes for the above-mentioned organ dysfunction have to be excluded. The clinical criteria along with imaging studies help in diagnosis. FES can be detected early by continuous pulse oximetry in high-risk patients. Treatment of FES is essentially supportive. Medications, including steroids, heparin, alcohol, and dextran, have been found to be ineffective.

The diagnosis of fatal pulmonary fat embolism using quantitative morphometry and confocal laser scanning microscopy

The postmortem diagnosis of fat embolism syndrome (FES), traditionally based on the histological demonstration of fat globules, needs a quantitative analysis of both the size and localization of the fat emboli, which is essential for a reliable grading of the pulmonary fat embolism. The clinical data and the autopsy records of 2738 autopsies were retrospectively evaluated, and 21 cases in which FES was pointed out as cause of death were selected and compared with 21 fatal cases referred to as major trauma in which the cause of death was not attributed to fat embolism, and with 47 fatal cases as control group, respectively. The following parameters were investigated: the total area of the embolized tissue; the total number of emboli; the mean area of the emboli; the mean percentage of the embolized tissue area as compared with the total tissue area of each sample; the total percentage of the embolized tissue area as compared with the total tissue area of all slides. The most reliable parameters seem to be the ratio between embolized tissue areas as compared with the total tissue area of each sample. These parameters showed a good correlation with the clinical data.

Fat embolism syndrome: Clinical and imaging considerations: Case report and review of literature

Fat embolism syndrome (FES) is a serious clinical disorder occurring after trauma, orthopedic procedures and rarely in non-traumatic patients. Fat emboli develop in nearly all patients with bone fractures, but they are usually asymptomatic. Small number of patients develop signs and symptoms of various organ system dysfunction due to either mechanical obstruction of capillaries by fat emboli or due to hydrolysis of fat to fatty acids. A triad of lung, brain and skin involvement develop after an asymptomatic period of 24 to 72 hours. This symptom complex is called FES. The incidence reported is up to 30%, but many mild cases may recover unnoticed. Diagnosis of fat embolism is clinical with nonspecific, insensitive diagnostic test results. Treatment of fat embolism syndrome remains supportive and in most cases can be prevented by early fixation of large bone factures. Here we report two cases of traumatic fat embolism, which were diagnosed initially by Gurd's criteria and subsequently confirmed by typical appearance on magnetic resonance imaging (MRI) of the brain in these patients. These patients were successfully treated with supportive management. In conclusion, diagnosis of FES needs high index of suspicion, exclusion of other conditions and use of clinical criteria in combination with imaging. Magnetic resonance imaging of the brain is of great importance in diagnosis and management of these patients.

Fat Embolism Syndrome

Fat embolism syndrome (FES) was first described in 1862, but its frequency today is still unclear. A diagnosis of FES is often missed because of a subclinical illness or coexisting confusing injuries or disease. Fat embolism syndrome develops most commonly after orthopedic injuries, but it has also been reported after other forms of trauma such as severe burns, liver injury, closed-chest cardiac massage, bone marrow transplantation, and liposuction. Although FES usually presents as a multisystem disorder, the most seriously affected organs are the lung, brain, cardiovascular system, and skin. Fat embolism syndrome is a self-limiting disease and treatment should be mainly supportive. Many drugs have been used to treat FES, but the results are inconclusive.

Nodular Pattern at Lung Computed Tomography in Fat Embolism Syndrome

The purpose of this study is to describe the computed tomography (CT) findings in pulmonary fat embolism syndrome (FES). The chest radiographs and CT scans of 5 patients with the diagnosis of FES as determined by the presence of at least 1 major and 4 minor criteria were reviewed. The radiologic features included ground-glass opacities, with different patterns of presentation seen in all patients. Three patients presented with alveolar opacities, and small (<1 cm) ill-defined nodules were seen in 4 of 5 patients. In the context of a patient with previous trauma and the clinical suspicion of FES, the presence of nodules at CT examination may be a helpful finding in the diagnosis of this entity. The chest radiographs and CT scans of 5 patients with the diagnosis of FES as determined by the presence of at least 1 major and 4 minor criteria as defined by Gurd and Wilson were reviewed.

Post-traumatic Severe Fat Embolism Syndrome with Uncommon CT Findings

Although the diagnosis of fat embolism syndrome is usually based on clinical findings, we describe ill-defined centrilobular and subpleural nodules in addition to ground-glass opacities and consolidation on a computed tomography scan of the chest in a trauma patient with fat embolism syndrome. The nodules presumably represent alveolar oedema, microhaemorrhage and an inflammatory response secondary to ischaemia and cytotoxic emboli in fat embolism syndrome. The literature of computed tomography findings in patients with fat embolism syndrome is reviewed and summarized.

Fat embolism in revision total hip arthroplasty

Two patients developed fat embolism syndrome after revision of loose total hip arthroplasties (THAs). During both procedures, the prosthesis became rigidly fixed 1 to 1.5 cm before the expected level of fixation. After uncomplicated operative courses, Patient A remained obtunded and febrile for 2.5 days, and Patient B died 1 day postoperatively. In Patient A, a presumptive diagnosis of fat embolism syndrome was based on the postoperative course and a radiograph of the lungs. In Patient B, the diagnosis was confirmed by evidence of cerebral edema on a computed tomography scan of the head. Fat embolism syndrome is unexpected after revision THA because the fatty tissue is removed from the femoral canal during primary THA. In these 2 cases, the rigid fixation and multiple attempts to impact and subsequently to remove the prosthesis may have caused fat embolism syndrome. Copyright 2002, Elsevier Science (USA). All rights reserved.

Early Diagnosis of Cerebral Fat Embolism Syndrome by Diffusion-Weighted MRI (Starfield Pattern)

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. 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.

PERIOPERATIVE MANAGEMENT OF SELECTED PROBLEMS IN PATIENTS WITH RHEUMATIC DISEASES

Patients undergoing surgery are subject to multiple perioperative problems. This article reviews several issues that occur in surgical patients with rheumatic diseases, including management of medications, diagnosis of fat embolism syndrome, prophylaxis against endocarditis, postoperative fever, and perioperative myocardial infarction.

Delayed Neurological Deficit After Total Hip Arthroplasty

Delayed Neurological Deficit After Total Hip Arthroplasty