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Fat Embolism Clinical Presentation

  • Author: Constantine S Bulauitan, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
 
Updated: Apr 06, 2015
 

History

The history of a patient with fat embolism may include the following:

  • Major blunt trauma, usually resulting in long-bone fractures, pelvic fractures, or both
  • Elective long-bone orthopedic procedures or cardiothoracic procedures
  • Parenteral lipid infusion
  • Recent corticosteroid administration
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Physical Examination

Gurd and Wilson have outlined an approach to diagnosing fat embolism syndrome (FES) on the basis of major and minor criteria.[24] One major criterion, four minor criteria, and the presence of macroglobulinemia are required for the diagnosis.

Major criteria for diagnosing FES are as follows:

  • Symptoms and radiologic evidence of respiratory insufficiency
  • Cerebral sequelae unrelated to head injury or other conditions
  • Petechial rash

Minor criteria are as follows:

  • Tachycardia (heart rate >110 beats/min)
  • Pyrexia (temperature >38.5° C)
  • Retinal changes of fat or petechiae
  • Renal dysfunction
  • Jaundice
  • Acute drop in hemoglobin level
  • Sudden thrombocytopenia
  • Elevated erythrocyte sedimentation rate
  • Fat microglobulinemia

Early signs of the systemic inflammatory response syndrome (SIRS) may herald the onset of FES. Tachypnea, dyspnea, and hypoxia appear as a result of ventilation-perfusion abnormalities 12-72 hours after injury.

Alert clinicians may notice reddish-brown nonpalpable petechiae developing over the upper body, particularly in the axillae, within 24-36 hours of insult or injury. These petechiae occur in 20-50% of patients and resolve quickly, but they are virtually diagnostic in the right clinical setting. Subconjunctival and oral hemorrhages and petechiae can also appear.[20]

Central nervous system dysfunction initially manifests as agitation or delirium but may progress to stupor, seizures, or coma and is frequently unresponsive to correction of hypoxia.[4] Retinal hemorrhages with intra-arterial fat globules are visible upon funduscopic examination.

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Contributor Information and Disclosures
Author

Constantine S Bulauitan, MD Surgical Critical Care Fellow, Division of Acute Care Surgery, Rutgers Biomedical and Health Sciences, Rutgers Robert Wood Johnson Medical School

Constantine S Bulauitan, MD is a member of the following medical societies: American College of Surgeons, Society of Critical Care Medicine, Philippine Medical Association of America, World Surgical Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Rajan Gupta, MD, FACS, FCCP Associate Professor of Surgery, Chief, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School

Rajan Gupta, MD, FACS, FCCP is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, Association for Academic Surgery, New Hampshire Medical Society, Shock Society, Society of Critical Care Medicine, Eastern Association for the Surgery of Trauma, European Society for Trauma and Emergency Surgery, Western Trauma Association, International Society of Surgery, International Association for Trauma Surgery and Intensive Care, New England Surgical Society

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

Acknowledgements

Lisa Kirkland, MD, FACP, CNSP, MSHA Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital

Lisa Kirkland, MD, FACP, CNSP, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
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Hematoxylin-eosin stain of section of lungs showing blood vessel with fibrinoid material and optical empty space indicative of presence of lipid dissolved during staining process. This 55-year-old woman died of massive fat embolism after developing pancreatitis due to endoscopic retrograde cholangiopancreatography. Image courtesy of Wikimedia Commons. Originally published in Kanen BL, Loffeld RJLF. Pancreatitis with an unusual fatal complication following endoscopic retrograde cholangiopancreaticography: a case report. Journal of Medical Case Reports. 2008;2:215.
Frozen section of lung stained with oil red O showing multiple orange red fat globules of varying sizes in septal vasculature. Image courtesy of Dr AVC Rao, Senior Lecturer in Pathology, The University of the West Indies at St Augustine, Trinidad and Tobago. Originally published in Journal of Orthopaedics (http://www.jortho.org/2008/5/4/e8/).
 
 
 
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