The three main symptoms of this condition, trouble breathing, mental status changes and petechial rash, are signs and symptoms that are usually visible. That means in many cases, especially those that are more severe, a physical examination is enough to diagnose this condition.
Fat embolism syndrome occurs when fat enters the blood stream (fat embolism) and results in symptoms. Symptoms generally begin within a day. This may include a petechial rash, decreased level of consciousness, and shortness of breath. Other symptoms may include fever and decreased urine output.
Fat embolism is the presence of fat particles within the microcirculation, while FES is the systemic manifestation of fat emboli within the microcirculation. Common systemic manifestations include respiratory distress, altered mental status, and a rash. FES is most often associated with orthopedic trauma.
Fat embolism and fat embolism syndrome are multiorgan diseases that can damage the kidneys, heart, skin, brain, and lungs. Fat embolism typically manifests at around 24 to 72 hours after the initial insult. The history should elicit the time and onset of symptoms.
Hypoxemia, tachypnoea, and dyspnoea are the initial findings. In some cases, the patients may progress to respiratory failure, requiring mechanical ventilation. [18] In other cases, if no ongoing embolism or infection occurs, the lung usually recovers by the third day.
Magnetic resonance imaging (MR) has been reported to be the most sensitive modality to diagnose cerebral fat embolism [48,49], suggesting it may be wise to perform cerebral MR in patients with acute alteration in mental status after orthopedic surgery or trauma in the presence of a normal cerebral CT scan [50].
Clinical Presentation
The classic triad of FES includes hypoxemia, neurological abnormalities, and petechiae. Pulmonary manifestations are among the most common initial signs of FES and include dyspnea, tachypnea, hypoxemia, and respiratory failure.
Fat embolism is most commonly associated with trauma. Long bone and pelvic fractures are the most frequent causes, followed by orthopedic surgery—particularly total hip arthroplasty—and multiple traumatic injuries. Soft tissue damage and burns can cause fat embolisms, although far less frequently than fracture.
It usually happens after a bone injury, when fat surrounding the bone and muscle gets into broken blood vessels. If a person develops symptoms, it means they have fat embolism syndrome. Most people with a fat embolism do not experience any symptoms. However, for those who do, the embolism can be life threatening.
Utilization of a vacuum or venting during reaming has been shown to decrease the incidence of fat embolization. Prophylactic placement of inferior vena cava filters may help reduce the volume of fat that reaches the heart in at-risk patients.
Fat emboli are a common phenomenon, but are rarely detected or reported on extremity CT imaging. We present a case of fat embolus in the popliteal vein in the setting of a femoral fracture. This is the most distal fat embolus described in the literature.
Chest x-ray findings may be subtle and CT is better suited to making the diagnosis. Three patterns are most frequently observed: ground-glass change with geographic distribution, ground-glass with interlobular septal thickening, and nodular opacities.
Chest X-ray in fat embolism syndrome is done in fat embolism to rule out the complications such as acute respiratory distress syndrome and any other possible diagnosis, for example, pulmonary embolism or pulmonary edema.
CT scan shows multiple areas of consolidation, ground-glass opacities and small (2–10 mm) nodules. These are predominantly seen in the upper lobes, whereas gravity-dependent opacities are predominantly seen in the lower lobes. 2 The nodules may represent inflamed intrapulmonary lymph nodes.
Overall, the mortality of FES is estimated to be 5–30%. Despite critical care improvement, a mortality rate as high as 30% was reported in a recent meta-analysis.
If you have a pulmonary embolism you'll have a sharp or stabbing chest pain that starts suddenly or comes on gradually. Shortness of breath, coughing up blood and feeling faint or dizzy, or passing out are also common symptoms.
Half the people who have pulmonary embolism have no symptoms. If you do have symptoms, they can include shortness of breath, chest pain or coughing up blood. Symptoms of a blood clot include warmth, swelling, pain, tenderness and redness of the leg.
Patients with pulmonary embolism report fatigue, anxiety and bodily hypervigilance.
Pulmonary embolism chest pain
You may experience pain that especially gets worse when you breathe, cough, or move. Pain does not decrease with rest and only worsens with activity.
The incidence of thromboembolism in plastic surgery procedures ranges from 0.5% to 9% in different studies performed by the American Society for Aesthetic Plastic Surgery.
Pulmonary fat embolism is a disease which may cause death if mechanical, toxic and shock-inducing effects lead to insufficiency of the cardio-respiratory system. In forensic cases death due to fat embolism should be diagnosed only after exclusion of other lethal factors.
Chest x-ray findings may be subtle and CT is better suited to making the diagnosis. Three patterns are most frequently observed: ground-glass change with geographic distribution, ground-glass with interlobular septal thickening, and nodular opacities.