Analysis of Pulmonary Fat Embolism in Blunt Force Fatalities

Mudd, K L; Hunt, Alice M.; Matherly, R C; Goldsmith, L. Jane; Campbell, F R; Nichols, George R.; Rink, R D

doi:10.1097/00005373-200004000-00020

Cited by 61 publications

(42 citation statements)

References 13 publications

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“…It is the leading cause of respiratory deterioration in blast victims who survive [13]. As no evidence of myeloid tissue was found in lung sections from blunt trauma victims, it is believed that soft tissue is the source of FE in these cases [14]. The almost ubiquitous finding of FE in cases of natural death is attributed to resuscitative measures [15].…”

Section: Incidencementioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

Eur Respir J

162

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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Section: Incidencementioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

Eur Respir J

162

127

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“…10 The presence of fat globules within lung capillaries is typically identified at autopsy on H&E-stained lung sections confirmed with Oil-Red-O staining of frozen-section tissue or formalinfixed osmium-stained tissue. 11 While the majority of medical examiner cases of pulmonary fat emboli are seen secondary to traumatic injuries, the pathogenesis of nontraumatic fat embolism as seen in sickle cell patients, although somewhat unclear, is thought to arise due to massive bone marrow infarction with subsequent embolization. 10,12 In addition to the known mortality related to acute pulmonary events, the clinically underreported chronic pulmonary complications are also associated with sudden and unexpected death in sickle cell patients.…”

mentioning

confidence: 99%

Sickle Cell Lung Disease and Sudden Death

Mosunjac²,

Rl³

2007

American Journal of Forensic Medicine &Amp; Pathology

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Sudden death in the setting of sickle cell lung disease (SCLD), is periodically seen in the practice of medical examiners. The goal of the present study was to identify the most common pathologic findings of SCLD associated with sudden or unexpected death. A retrospective/prospective review of 21 autopsy cases from sickle cell patients between 1990 and 2004 was performed. Review of medical records, autopsy reports, and H&E-stained slides of lung tissue was performed. Oil-Red-O and elastic staining of lung tissue were evaluated. All cases were screened for both acute and chronic forms of SCLD. Patients admitted for sickle cell pain crisis ranged in age from 8 months to 65 years. Fifteen out of 21 cases (71.4%) showed significant pulmonary pathology. The most frequent lung findings included pulmonary edema (47.6%), pulmonary thromboembolism (38.1%), fat emboli (33.3%), pulmonary hypertension, grades I-IV (33.3%), and microvascular occlusive thrombi (28.5%). Our study demonstrates higher-than-expected percentages of acute and chronic sickle cell-related lung injury such as fat embolism (33.3%) and pulmonary hypertension (33.3%), with right ventricular hypertrophy (33.3%). Therefore, we propose a simple and high-yield autopsy algorithm of ancillary procedures that should be applied on all known and suspected autopsy cases of sickle cell disease.

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“…Genellikle sistemik yayılım olmaksızın, evre I ve II yağ embolisi olguları, eşlik eden k l i n i k b u l g u l a r y o k s a ö l ü m n e d e n i o l a r a k değerlendirilmemektedir (1). İzole pulmoner yağ embolisinin yaygın olduğu durumlarda (evre III ve üzeri olgularda) ölüm nedeni olarak değerlendirilebileceği bildirilmiştir (12). Turan ve arkadaşları adli otopsilerde ölüm nedeni olarak akciğer ve sistemik yağ embolizmini araştırdıkları çalışmalarında; 15 olguda (%48) evre III, 11 olguda (%35) evre IV yağ embolisi olmak üzere toplam 26 olguda saptanan akciğer embolisi değerlerinin öldürücü nitelikte bulunduğu bildirmiştir ( .…”

Section: Discussionunclassified

Akciğerde Yağ Embolisine Bağlı Ölüm Olgu Sunumu

İlhan¹,

Özen²,

Beder³

et al. 2014

Bull Leg Med

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Yağ embolisi, genellikle ciddi travma veya cerrahi girişim sonrası kemik iliğinden ya da yumuşak dokulardan yağ damlacıklarının serbestleşip sistemik dolaşıma geçmesidir. Gençlerde daha çok uzun kemik kırıklarından sonra, yaşlılarda ise kalça kırığı sonrası gelişmektedir. Genellikle travmadan 24-48 saat sonra ortaya çıkan klinik tablo, hafif olabileceği gibi solunum yetmezliği ve ölüme kadar ilerleyebilir. Sunulan olgu; 84 yaşında kadın olup, araç dışı trafik kazası nedeni ile sol kolda ve sol pelvik bölgede ağrı yakınmalarıyla hastaneye başvurmuştur. Ortopedi konsültasyonunda; sol omuz çıkığı, sol humerus suprakondiler kırığı ve sol ramus pubis kırığı nedeniyle kapalı redüksiyon uygulanarak taburcu edilmiş ve kazadan yaklaşık üç saat sonra evinde öldüğü bildirilmiştir. Şüpheli ölüm olarak değerlendirilen adli olguya yapılan otopside; akciğer kesitlerinde yer yer köpüklü hemorajik özellikli sıvı çıkışı, sol omuz çıkığı, sol humerus suprakondiler kırığı ve sol ramus pubiste deplase kırık hattı görüldü. Postmortem histopatolojik incelemede; akciğerlerde interstisiyel kapiller lümenlerde evre IV yağ embolisi ve orta çaplı pulmoner damarlarda yaygın kemik iliği embolizasyonu tespit edildi. Olayın öyküsü, tıbbi belgelerin içeriği, otopsideki makroskopik ve histopatolojik inceleme verilerine göre, kişinin ölümünün araç dışı trafik kazası sonrası genel beden travmasına bağlı ekstremite kırıklarıyla birlikte akciğerde yağ embolisi sonucunda geliştiği belirlendi.Travma ile oluşan kemik kırıkları sonrası yağ embolisi oluşumunu önlemek için, kırıkların erken fiksasyonu ve immobilizasyonu önemlidir. Bu olgularının takip ve tedavisinde dikkatli olunması, tıbbi uygulama hatalarının önlenmesi yönünden de önem taşımaktadır. Ayrıca trafik kazası ile kemik kırıkları tespit edilen ve şüpheli ölüm olarak değerlendirilen olgularda otopsi ve postmortem histopatolojik incelemenin tanıyı belirlemede katkısı olduğu açıktır.Anahtar Kelimeler: Yağ embolisi, travma, adli tıp, otopsi, şüpheli ölüm.

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Analysis of Pulmonary Fat Embolism in Blunt Force Fatalities

Cited by 61 publications

References 13 publications

Nonthrombotic pulmonary embolism

Nonthrombotic pulmonary embolism

Sickle Cell Lung Disease and Sudden Death

Akciğerde Yağ Embolisine Bağlı Ölüm Olgu Sunumu

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