Lung fat embolism in a body changed by putrefaction: a hip fracture antemortem in origin

Nikolić, Slobodan; Živković, Vladimir; Strajina, Veljko; Djonić, Danijela; Popović, Vladimir; Djurić, Marija

doi:10.1258/msl.2011.011024

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…Fat embolism is most commonly associated with trauma (i.e. fractures) [1][2][3] , however there is relatively small number of described cases of fat embolism in the absence of trauma, associated with alcoholic or steroid-induced fatty liver, acute hepatic necrosis or diabetes [4][5][6][7][8] , and only a few papers of postoperative fat embolism 9 . One of studies found quite surprising incidence of fat embolism in cases of sudden deathin 34 out of 65 cases 10 .…”

Section: Discussionmentioning

confidence: 99%

“…A presence of fat droplets in the lung circulation presents a pulmonary fat embolism. With the obstruction of the sufficient percent of pulmonary vessels by the fat emboli, with the exceeding of its compensatory capabilities, an acute right heart failure may develop [1][2][3] . Commonly, the lung fat embolism after sustained trauma is a subclinical event: droplets of fat are sucked into the venous system at a site of fracture and then get stuck in the pulmonary circulation.…”

Section: Introductionmentioning

confidence: 99%

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Iatrogenic pulmonary fat embolism after surgery in a patient with fatty liver

Mitrović

Lazarevic

2020

VOJNOSANIT PREGL

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Introduction. Fat embolism refers to the presence of fat globules in the lung parenchyma and its peripheral circulation. Obstruction of the lung vessels by fat emboli can lead to acute cor pulmonale when the compensatory capabilities of the pulmonary vasculature are exceeded. Case report. We presented a case of a 78-year old man who suffered a dissection of abdominal aortic aneurysm. Urgent surgical procedure was performed and aneurysm replaced with aortobifemoral bypass grafting using a Dacron graft. Despite the procedure the patient died the following day. The autopsy revealed that the cause of death was hypovolemic shock. There were no bone fractures (also no fractures of ribs and sternum from cardiopulmonary resuscitation) or injuries of the subcutaneous fat tissue or other organs (besides those from the surgery). However, additional autopsy findings included fatty liver change, small liver hemorrhages (confirmed microscopically), as well as a presence of fat droplets in the hepatic veins, as well as in the pulmonary vessels, i.e. pulmonary fat embolism [confirmed with hematoxylin/eosin (H/E), and Sudan III staining], which could be the contributing cause of death. Conclusion. The presented case indicates that pulmonary (or even systemic) fat embolism should be considered as the possible iatrogenic cause of unexpected and unexplained death in the cases where elective surgical procedures were performed in patients with fatty liver change. Pathologists must be aware of this possibility, since it is not easily recognized on routine H/E staining, and some of the special staining technique should be applied.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Iatrogenic pulmonary fat embolism after surgery in a patient with fatty liver

Mitrović

Lazarevic

2020

VOJNOSANIT PREGL

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“…Fat embolism has been identified with putrefaction present. Nikolić and colleagues identified pulmonary fat embolism in an 80-year-old female with a hip fracture using Sudan III-stained frozen sections (46). In the study of Voisard and colleagues, small amounts of fat were found in nontraumatic cases with putrefaction (45).…”

Section: Review Articlementioning

confidence: 99%

Fat Embolism, Fat Embolism Syndrome and the Autopsy

Milroy¹,

Parai²

2019

Academic Forensic Pathology

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Fat embolism is common following trauma and is a common autopsy finding in these cases. It may also be seen in non-traumatic cases and is seen in children as well as adults. In comparison fat embolism syndrome (FES) only occurs in a small number of trauma and non-trauma cases. Clinical diagnosis is based on characteristic clinical and laboratory findings. Fat embolism exerts its effect by mechanical blockage of vessels and/or by biochemical means including breakdown of fat to free fatty acids causing an inflammatory response. Fat embolism can be identified at autopsy on microscopy of the lungs using fat stains conducted on frozen tissue, including on formalin fixed but not processed tissue. With FES fat emboli can be seen in other organs including the brain, kidney and myocardium. Fat can also be identified with post-fixation staining, typically with osmium tetroxide. Scoring systems have been developed to try and determine the severity of fat embolism in lung tissue. Fat embolism is also common following resuscitation. When no resuscitation has taken place, the presence of fat on lung histology has been used as proof of vitality. Diagnosis of fat embolism syndrome at autopsy requires analysis of the history, clinical and laboratory findings along with autopsy investigations to determine its relevance, but is an important diagnosis to make which is not always identified clinically. This paper reviews the history, clinical and laboratory findings and diagnosis of fat embolism and fat embolism syndrome at autopsy.

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“…The histological finding of fat emboli using some of special stains (Sudan, Oil Red O, etc.) in the lungs is possible even in cases of advanced putrefaction (2).…”

Section: Sirmentioning

confidence: 99%