Fat Embolism Syndrome

Fat Embolism Syndrome: A Case Report and Review Literature

“…Mechanical theory, described by Gossling et al [3], states that increased intramedullary pressure after an injury forces marrow to pass into injured venous sinusoids causing large fat droplets to be released into the venous system. These fat droplets then travel to the lungs and occlude pulmonary capillaries and systemic vasculatures.…”

Embolia gordurosa: uma revisão para a prática ortopédica atual

“…Indeed, it is worthy to emphasize that even external cardiac massage creates reasonable degrees of FE, which was detected in 40 to 85% of autopsied cases (8,35) . Other milder orthopaedic procedures, such as the manipulation of Wagner's stretcher, for example, have already caused fatal FES (13) . Similarly, here in our Service, we had the opportunity to see two cases of severe FES after a simple injection of medullary aspirate in a pseudoarthrosis focus.…”

“…Despite of the extensive trauma caused by liposuction cannula, the resulting FE is almost always little when compared to that occurring after fractures. The reason for this difference is that, in the bone, venules and sinusoids, for having their walls at- other hand, if FE is massive enough to occlude about 80% of the pulmonary capillary meshwork (13) there will be a great increase of pulmonary artery pressure and, as a result, right ventriculum acute failure (acute "cor-pulmonale"), with a rapid progression to death (1,2,5,10,15,49,50) . This may happen in a healthy young individual, while in an elderly patient and/or with a lower cardiopulmonary reserve, the "cor-pulmonale" probably arises after much less extensive embolisms (1,2,11,48) .…”

“…However, there are some mechanisms by which fat emboli can damage other organs, as severely as the lungs, but via arterial flow: 1st) Through anatomical pulmonary arteriovenous micro fistulas. According to Goslling et al (12,13) , glass spheres with a diameter 20 to 40 times larger than pulmonary capillary reach the systemic flow after passing by those fistulas. 2nd) Through deformation of the fat droplet itself, which, by taking a more elongated form, would manage to pass through pulmonary capillaries (3) .…”

“…It was also noticed that, even in individuals in whom this foramen was closed, it could be opened by the occurrence of acute pulmonary hypertension such as those that may occur in a massive FE (5,6,8) . In arterial-path FE, the mostly affected organs are the brain (1,2,5,6,(18)(19)(20)(21) , skin (petechiae), and retina (13,19,20,(22)(23)(24)(25) . In thorough autopsies of car accident victims, however, fat emboli are also frequently found in kidneys, spleen, liver, adrenals, and myocardium (20,(24)(25)(26)(27) .…”