Fat Embolism Clinical Presentation

Updated: Mar 08, 2022
  • Author: Constantine S Bulauitan, MD; Chief Editor: Vincent Lopez Rowe, MD, FACS  more...
  • Print


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

Physical Examination

Gurd and Wilson outlined an approach to diagnosing fat embolism syndrome (FES) on the basis of major and minor criteria. [19] 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. [9]

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. [20] Retinal hemorrhages with intra-arterial fat globules are visible upon funduscopic examination.