Fat embolism syndrome (FES) occurs when fat particles are aberrantly distributed into the microcirculation, and it often manifests as either hypoxemia, neurological deficit, or petechial rash. Although cases have been reported in the literature since the twentieth century, no formal diagnostic criteria have been universally adopted, and FES remains a diagnostic challenge. We present a unique case of FES from a long bone fracture, leading to pulmonary embolism with paradoxical arterial embolization and cerebral infarction, and provide a review of the related literature.

Background and aims: Assessments of disease activity in rheumatoid arthritis plays an important role in determining treatment plans and patient response to treatment. The aims of this study was to describe the power Doppler ultrasound features of wrist joints in patients with rheumatoid arthritis and evaluate role of power Doppler ultrasoundin assessing disease activity in patients withrheumatoid arthritis. Material and method: This present study included 30patients diagnosed with rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria, who were admitted in the period July 2017 to April 2018 in Department of Nephrology and Rheumatology, Hue Central Hospital. All patients were physical examination, laboratory investigations, assessment disease activity score in 28 joints using CRP (DAS28-CRP), clinical disease activity index (CDAI), simplified disease activity index (SDAI). Grey scale ultrasound and power Doppler ultrasound were used to assess synovitis, effusion and tenosynovitis and synovial vascularity of 60 wrist joints. Power Doppler was graded using a validated semiquantitative scroring system, which consists of scale of 0-3. Result: Twenty-seven wrist joints (45.0%) had synovitis in grey scale ultrasound. Thirty-seven wrist joints (61.7%) had a power doppler signal, 18.3% had grade 1 (low), 21.7% had grade 2 (moderate) and 21.7% had grade 3 (high). Level of angiogenesis in PDUS with semiquantitative scroring systemweresignificantly correlated with tender joint count, swollen joint count, global VAS, CRP and CDAI, SDAI, DAS28-CRP. Conclusions: Power Doppler ultrasound of wrist joints could be used as a non-invasive and feasible method to assessing disease activity in patients with rheumatoid arthritis. Key words: rheumatoid arthritis, power Doppler ultrasound