Fat embolism syndrome

Abstract

Fat embolism syndrome is an often overlooked cause of breathlessness in trauma wards. Presenting in a wide range of clinical signs of varying severity, fat embolism is usually diagnosed by a physician who keeps a high degree of suspicion. The clinical background, chronology of symptoms and corroborative laboratory findings are instrumental in a diagnosis of fat embolism syndrome. There are a few diagnostic criteria which are helpful in making a diagnosis of fat embolism syndrome. Management is mainly prevention of fat embolism syndrome, and organ supportive care. Except in fulminant fat embolism syndrome, the prognosis is usually good.

Suspected coronary fat embolism after liposuction

“…Fat embolism can occur after pelvic and long bone fractures, orthopedic surgery, severe burns, trauma, pancreatitis, sickle cell anemia, and liposuction . Fat embolism after liposuction is a rare complication, although the exact risk and incidence is not known possibly due to varying criteria for diagnosis and the milder forms undetected clinically . During the procedure, damage to the adipocytes and rupture of vessels occur, allowing microemboli of lipids to enter the venous circulation .…”

“…FES refers to the clinical manifestations of fat embolism, which include a triad of respiratory insufficiency, altered mental status, and petechiae. Systemic manifestations, such as stroke, can occur due to passing of fat through a patent foramen ovale, pulmonary arteriovenous malformations, or by passing of deformed fat globules through pulmonary capillaries . In this case, the fat could have passed to the systemic circulation and then to the coronary arteries by an undiagnosed PFO versus one of the other two mechanisms mentioned.…”

“…Fat embolism after liposuction is a rare complication, with fat embolism syndrome (FES) resulting in a 5%–15% mortality . There have been reports of fat emboli to the pulmonary and cerebral circulation as a result of liposuction .…”

Fettpartikler i blodet

“…Det har vaert kjent siden 1800-tallet og ble første gang beskrevet som syndrom i 1873 av den tyske kirurgen Ernst von Bergmann i Berliner Medicinische Wochenschrift (2). Som Diab og medarbeidere skriver er insidensen usikker og sannsynligvis betydelig underrapportert, fordi de fleste tilfeller vil vaere subkliniske.…”

“…Den fulminante formen oppstår raskt, med respirasjonssvikt, mental konfusjon og død i et bilde av akutt høyresidig hjertesvikt (2). Subkliniske tilfeller forekommer sannsynligvis nesten alltid ved brudd i de lange rørknokler og vil manifestere seg som et forbigående fall i oksygenmetningen, uten større klinisk betydning, og blir gjerne satt i forbindelse med andre medfølgende tilstander som smertereaksjon og postoperativ inflammatorisk respons.…”