MyMedR

Fulltext Cortical Blindness In Fat Embolism Syndrome Following Fracture Manipulative Procedure

Shahrulazua, A., Ariff, M.S., Aziz, M.A.

Malays Orthop J, 2010;4(1):35-38.

MyJurnal

Fat embolism syndrome is a well-recognised sequela of long bone trauma as well as intramedullary orthopaedic procedures. However, it has rarely been described following manipulation, reduction of fracture, and application of external fixator. Furthermore, bilateral ocular blindness is seldom the first manifestation; instead respiratory and other cerebral symptoms being most common. We describe a case with this rare presentation in a patient who underwent a trial of closed reduction, then open reduction of a femur fracture, followed by external fixation performed at day 47 post-initial trauma.

Matched MeSH terms: Embolism, Fat

Fulltext Two variants of fat embolism syndrome evolving in a young patient with multiple fractures

Bajuri MY, Johan RR, Shukur H

BMJ Case Rep, 2013;2013.

PMID: 23576653 DOI: 10.1136/bcr-2013-008631

Fat embolism syndrome (FES) is a continuum of fat emboli. Variants of FES: acute fulminant form and classic FES are postulated to represent two different pathomechanisms. Acute fulminant FES occurs during the first 24 h. It is attributed to massive mechanical blockage pulmonary vasculature by the fat emboli. The classic FES typically has a latency period of 24-36 h manifestation of respiratory failure and other signs of fat embolism. Progression of asymptomatic fat embolism with FES frequently represents inadequate treatment of hypovolaemic shock. We present a rare case of two variants of FES evolving in a patient with multiple fractures to emphasis the importance of adequate and appropriate treatment of shock in preventing the development of FES. Since supportive therapy which is a ventilatory support remains as the treatment of FES, it is appropriate to treat FES in the intensive care unit setting.

Matched MeSH terms: Embolism, Fat/etiology*; Embolism, Fat/radiography*; Embolism, Fat/therapy

Fulltext A case of two common culprits causing pulmonary embolism

Timothy, C.T.J., Mansor, A., Wengvei, C.T.K.

JUMMEC, 2017;20(1):1-3.

MyJurnal

Pulmonary embolism is the obstruction of the pulmonary artery or its branches, commonly by thrombus or
fat. We report an unusual case of double pathology - both pulmonary thromboembolism and fat embolism
syndrome in a patient with bilateral femur and bilateral tibia fractures. This highlights the importance of a high
index of suspicion of these conditions while managing patients with multiple long bone fractures. Morbidity
and mortality can be significantly reduced with prompt and appropriate prevention strategies.

Matched MeSH terms: Embolism, Fat

Medico-legal aspects of embolism with a case illustration

Sarvesvaran R

Malays J Pathol, 1991 Dec;13(2):89-100.

PMID: 1823096

An adult male sustained a number of stab injuries and other injuries including a fatal stab injury to the neck. There was evidence of air embolism which was considered to be a major factor causing death. The discussion is in four parts. Part I is confined to the post mortem examination. Part II relates to the medico-legal aspects of the case. Part III is a general discussion on embolism and its medico-legal significance whilst Part IV is on the medico-legal aspects of air embolism.

Matched MeSH terms: Embolism, Fat/complications; Embolism, Fat/pathology

Fulltext Fat Embolism Syndrome - A Qualitative Review of its Incidence, Presentation, Pathogenesis and Management

Timon C, Keady C, Murphy CG

Malays Orthop J, 2021 Mar;15(1):1-11.

PMID: 33880141 DOI: 10.5704/MOJ.2103.001

Fat Embolism Syndrome (FES) is a poorly defined clinical phenomenon which has been attributed to fat emboli entering the circulation. It is common, and its clinical presentation may be either subtle or dramatic and life threatening. This is a review of the history, causes, pathophysiology, presentation, diagnosis and management of FES. FES mostly occurs secondary to orthopaedic trauma; it is less frequently associated with other traumatic and atraumatic conditions. There is no single test for diagnosing FES. Diagnosis of FES is often missed due to its subclinical presentation and/or confounding injuries in more severely injured patients. FES is most frequently diagnosed using the Gurd and Wilson criteria, like its rivals it is not clinically validated. Although FES is a multi-system condition, its effects in the lung, brain, cardiovascular system and skin cause most morbidity. FES is mostly a self-limiting condition and treatment is supportive in nature. Many treatments have been trialled, most notably corticosteroids and heparin, however no validated treatment has been established.

Matched MeSH terms: Embolism, Fat

Fulltext Characteristic imaging findings in pulmonary fat embolism syndrome (FES)

Ong SCL, Balasingam V

BMJ Case Rep, 2017 Nov 23;2017.

PMID: 29170189 DOI: 10.1136/bcr-2017-223007

Matched MeSH terms: Embolism, Fat/therapy

Fulltext Computed tomographic findings of cerebral fat embolism following multiple bone fractures

Law HL, Wong SL, Tan S

Singapore Med J, 2013 Feb;54(2):e28-30.

PMID: 23462838

Fat embolism to the lungs and brain is an uncommon complication following fractures. Few reports with descriptions of computed tomographic (CT) findings of emboli to the brain or cerebral fat embolism are available. We report a case of cerebral fat embolism following multiple skeletal fractures and present its CT findings here.

Matched MeSH terms: Embolism, Fat/diagnosis*

Fulltext Fat embolism syndrome treated with methylprednisolone: a different perception or a misconception?

Mohd Shaffid Md Shariff, Hanizah Ngadiron, Firdaus Hayati, Affirul Chairil Ariffin

Borneo Journal of Medical Sciences, 2017;11(3):45-48.

MyJurnal

Fat embolism syndrome is manifested by the fat globule presence in the pulmonary and systemic circulation. A 34-year-old man was involved in a motor vehicle accident with a fracture of the left femur and avulsion fracture of the left posterior cruciate ligaments. He developed signs and symptoms that suggested an early diagnosis of fat embolism syndrome. Intravenous methylprednisolone administration was administered as part of the treatment. The role of methylprednisolone in a patient with fat embolism syndrome is controversial due to unproven effectiveness. In this case, fat embolism syndrome after a femur fracture was treated successfully with methylprednisolone.

Matched MeSH terms: Embolism, Fat

Fulltext Fat embolism in right internal jugular vein: incidental ultrasound finding during internal jugular vein cannulation

Adi O, Fong CP, Azil A, Wahab SFA

Ultrasound J, 2019 Feb 25;11(1):1.

PMID: 31359296 DOI: 10.1186/s13089-019-0116-9

BACKGROUND: We report a case study of fat embolism seen on ultrasound at right internal jugular vein during central venous cannulation in a patient diagnosed with fat embolism syndrome. This case demonstrates the importance of ultrasound for evaluation of trauma cases with suspicion of fat embolism.

CASE PRESENTATION: A 23-year-old trauma patient with closed fracture of left femoral shaft and left humerus presented to our emergency department (ED). 11 h after admission to ED, patient became confused, hypoxic and hypotensive. He was then intubated for respiratory failure and mechanically ventilated. Transesophageal ultrasound revealed hyperdynamic heart, dilated right ventricle with no regional wall abnormalities and no major aorta injuries. Whole-body computed tomography was normal. During central venous cannulation of right internal jugular vein (IJV), we found free floating mobile hyperechoic spots, located at the anterior part of the vein. A diagnosis of fat embolism syndrome later was made based on the clinical presentation of long bone fractures and fat globulin in the blood. Despite aggressive fluid resuscitation, patient was a non-responder and needed vasopressor infusion for persistent shock. Blood aspirated during cannulation from the IJV revealed a fat globule. Patient underwent uneventful orthopedic procedures and was discharged well on day 5 of admission.

CONCLUSIONS: Point-of-care ultrasound findings of fat embolism in central vein can facilitate and increase the suspicion of fat embolism syndrome.

Matched MeSH terms: Embolism, Fat

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