Fat embolism syndrome: Case report of a clinical conundrum

Nandi, Roneeta; Venkategowda, Pradeep M; Mutkule, Dnyaneshwar P; Rao, S Manimala

doi:10.4103/0970-9185.137281

Cited by 2 publications

(7 citation statements)

References 8 publications

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“…33 The fat released obstructs the macrovasculature and microvasculature of the organs leading to organ dysfunction. 34 The clinical symptoms that are manifested depend on the affected organ. 21 Neither hypothesis can fully explain the occurrence of FES but rather FES is thought to be a combination of both biochemical and mechanical factors.…”

Section: Pathophysiologymentioning

confidence: 99%

“…21 Neither hypothesis can fully explain the occurrence of FES but rather FES is thought to be a combination of both biochemical and mechanical factors. 34 Mechanical forces can release fat emboli into the pulmonary and systemic circulation, and the biochemical reactions of free fatty acids lead to local inflammation and tissue injury of the organs. 35 In patients with SCD, it is proposed that extensive bone marrow necrosis release fat and necrotic material into the circulation leading to the development of FES.…”

Section: Pathophysiologymentioning

confidence: 99%

“…21,22,37,40 Skin findings can present as transient petechiae involving the neck, chest, and axilla and usually appears within 24 to 48 hours and disappears in 7 days. 21,34,37 Fat Embolism Syndrome Indices and Scoring Systems Fat embolism syndrome is diagnosed based on the clinical and laboratory findings and after other causes have been excluded. 37 Several criteria have been proposed to aid in the diagnosis of FES.…”

Section: Diagnosismentioning

confidence: 99%

“…28,51 However, with regard to a direct benefit in FES, corticosteroid therapy remains controversial. 22,34 Intravenous isotonic fluids should be administered where there is evidence of an electrolyte disturbance, hypotension, and shock in an effort to maintain adequate tissue perfusion. 58,59 However, in patients with ACS, caution must be taken to ensure an even fluid balance and to avoid hypervolemia that can lead to pulmonary edema.…”

Section: Managementmentioning

confidence: 99%

“…[61][62][63] Heparin is thought to activate lipase activity promoting clearance of lipids in the blood. 34 However, anticoagulation in ACS has not shown to be beneficial, and its role in FES remains controversial. 5,22,34 Thus, we do not recommend prophylactic or therapeutic anticoagulation in patients with SCD, ACS, and FES.…”

Section: Managementmentioning

confidence: 99%

See 4 more Smart Citations

Integrating Fat Embolism Syndrome Scoring Indices in Sickle Cell Disease: A Practice Management Review

Bailey

Wesley

Adeyinka

et al. 2017

J Intensive Care Med

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Fat embolism syndrome (FES) has been described in the literature as a rare complication of sickle cell disease (SCD). A review article published in 2005 reported 24 cases of FES associated with SCD. In many cases, a definitive diagnosis of FES in SCD is made on autopsy because of the lack of early recognition and the paucity of sensitive and specific testing for this syndrome. Patients with FES usually have a fulminant, rapidly deteriorating clinical course with mortality occurring within the first 24 hours. We postulate that FES is not well recognized in SCD and that FES scores are useful diagnostic tools in patients with SCD. We queried the electronic medical records with the diagnostic codes for SCD with acute chest syndrome (ACS), pulmonary embolism, or acute respiratory distress syndrome admitted to our hospital from 2008 to 2016 to identify patients suspected of having FES. In addition, we performed an extensive literature review to evaluate the management practice of pediatric patients with FES and SCD from 1966 to 2016. Six patients met our selection criteria from the hospital records, and 4 case reports from the literature search were also included. We applied the Gurd and Wilson criteria and the Schonfeld Fat Embolism Index to identify patients who met the criteria for FES. Nine patients fulfilled Gurd and Wilson criteria, and 9 patients who were evaluable met the Schonfeld criteria for FES. A rapidly deteriorating clinical course in a patient with SCD presenting with ACS or severe vaso-occlusive crisis should trigger a high index of suspicion for FES. Gurd and Wilson criteria or the Schonfeld Fat Embolism Index are useful diagnostic tools for FES in SCD.

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Section: Pathophysiologymentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

See 3 more Smart Citations

Integrating Fat Embolism Syndrome Scoring Indices in Sickle Cell Disease: A Practice Management Review

Bailey

Wesley

Adeyinka

et al. 2017

J Intensive Care Med

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From Cosmetic Surgery to Critical Care: Clinical Mimicry of Acute Respiratory Distress Syndrome Following Gluteal Augmentation Surgery

Iyer,

Sinha,

Rodriguez

et al. 2024

Cureus

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Gluteal augmentation surgery, commonly known as the Brazilian Butt Lift (BBL), has become increasingly popular and is offered at numerous surgical centers. Typically performed on an outpatient basis, the procedure takes less than four hours, making it an appealing option for many patients. However, BBL is associated with multiple complications, some of which can be severe, resulting in high mortality rates. Most such post-operative adverse events necessitate urgent transfer to hospitals for optimal care, with post-operative respiratory distress being one such critical sign. Fat embolism syndrome (FES) is a notable complication of BBL. The diagnosis of FES is primarily clinical, supported by imaging studies such as chest X-rays and CT scans. FES often goes underdiagnosed due to the lack of definitive diagnostic criteria and its clinical and radiological similarities to other conditions. Despite its underdiagnosis, FES is reported in approximately 0.06% of patients undergoing BBL. Failure to diagnose it early can lead to complications from empiric treatment of other suspected conditions, potentially worsening the prognosis. Our patient developed respiratory failure within an hour after undergoing BBL. The time to symptom onset and the patient's agitation before the respiratory episode broadened the differential for her condition. This case report highlights the importance of recognizing FES and exploring potential preventive measures, including advancements in surgical techniques and prophylactic strategies.

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Fat embolism syndrome: Case report of a clinical conundrum

Cited by 2 publications

References 8 publications

Integrating Fat Embolism Syndrome Scoring Indices in Sickle Cell Disease: A Practice Management Review

Integrating Fat Embolism Syndrome Scoring Indices in Sickle Cell Disease: A Practice Management Review

From Cosmetic Surgery to Critical Care: Clinical Mimicry of Acute Respiratory Distress Syndrome Following Gluteal Augmentation Surgery

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