An autopsy case of non‐traumatic fat embolism syndrome

Abstract

Fat embolism syndrome (FES) occurs after long bone fractures and the symptoms appear 24-72 h after the initial trauma. Fat emboli can affect both the pulmonary and systemic circulation. Apart from the most common type of FES that originates from bone fracture, non-traumatic FES has been also reported. We have experienced an autopsy case of non-traumatic FES. An 81-year-old man with hepatocellular carcinoma associated with alcoholic liver cirrhosis suddenly lost consciousness before transcatheter arterial chemoembolization treatment for his disease and died 5 h after the episode. At autopsy, numerous fat droplets were detected in the alveolar capillaries of the lung and glomerular capillaries of the kidney. Lipid analysis of lung autopsy specimens by thin-layer chromatography showed that the emboli were composed mainly of tristearin. Free fatty acids (FFA) has been considered to be the main component of fat emboli and can be a cause of acute respiratory distress syndrome (ARDS). However, in the present case, the lung specimen contained tristearin and ARDS did not occur. This is the first report of non-traumatic FES in which lipid analysis of human autopsy specimens has been conducted.

Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports

“…In an ideal scenario, a diagnostic methodology or blood test specific for FES would be available. Of course, other pathologies are able to cause "non-traumatic" fat embolism (NTFE), such as sickle cell crisis, fatty liver disease, total parenteral nutrition, prolonged steroid use and non-traumatic joint arthroplasty [46,47]. FE has been reported in the perinatal period around childbirth, although extremely rare [48].…”

The Case | Acute kidney injury after liver and kidney transplantation

“…Nontraumatic fat embolism syndrome has been reported with many etiologies: pancreatitis, diabetes, panniculitis, alcoholic fatty liver disease, and cyclosporine A solvent. 1,2 Fat embolism syndrome is characterized by the presence of circulating fat emboli/macroglobules that occlude capillaries and lead to multisystem dysfunction, typically with respiratory, neurological, and dermatological symptoms and rarely involving the kidney. Some cases can present with atypical features such as isolated renal involvement without the classic manifestations, as in our patient.…”

Rare, Fatal Pulmonary Fat Embolism after Acupuncture Therapy: A Case Report and Literature Review

“…It has been reported that biochemical testing of the deceased's cardiac blood should be performed, with attention to abnormal changes in VLDL, cholesterol, TG, FFA, and CRP [3]. Lipid analysis of fat emboli, if necessary, may also be performed, which may suggest a possible mechanism of pulmonary fat embolism formation [4]. Moreover, attention should be paid to individual factors and subclinical conditions, such as obesity, multiple organ adipose hyperplasia and other condition, that may be risk factors for nontraumatic fat embolism [3].…”

“…It is most frequently observed following severe trauma, particularly long bone fractures and contusions in soft tissue rich in adipose tissue. Nontraumatic pulmonary fat embolism associated with minor soft tissue contusion [2,3], surgery, cancer chemotherapy, hematologic disorders and so on has also been reported [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Intrinsic or extrinsic stimuli evokes a biological response, known as stress [19]; stress can be induced by trauma, blood loss, hypoxia, pain, heat and cold, fear, infection, surgery, and anesthesia.…”

“…PubMed was searched with different combinations of the following keywords: "fat embolism", "nontraumatic", "death", "autopsy", and "case report". Table 1 lists 18 case reports [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] (including this case report) of nontraumatic fat embolism caused by stress, summarized by year, PMID, author age, sex, underlying disease, stress factors, early clinical manifestations, diagnosis tool, affected organs and deterioration. None of these cases had severe fatty tissue damage or long bone fractures, and those with surgical trauma had only minor adipose tissue damage.…”