Diffuse Alveolar Hemorrhage: A Rare Manifestation of Trauma

Allan, Patrick F.; Amjadi, Darius; Haynes, Ralph L.

doi:10.7205/milmed-d-10-00432

Cited by 8 publications

(12 citation statements)

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“…Causes of DAH are diverse. It is known that trauma or a long bone fracture are associated with DAH [3,4]. To the best of our knowledge, this is the first case of DAH during long bone fracture operation reported in the literature.…”

mentioning

confidence: 75%

“…It has been reported that fat embolism and DAH can occur in association with an orthopedic injury and repair [4,7]. A fat embolism rarely presents as a macroembolism with a visible obstruction of the pulmonary artery on radiologic imaging [8].…”

Section: Discussionmentioning

confidence: 99%

“…DAH is a medical emergency because significant morbidity and mortality are associated with delayed treatment [3,4] DAH results in the accumulation of intra-alveolar red blood cells originating from alveolar capillaries. All causes of DAH are associated with injury to alveolar microcirculation [2].…”

Section: Discussionmentioning

confidence: 99%

“…DAH is a medical emergency that often results in acute respiratory failure [3,4]. Causes of DAH are diverse.…”

mentioning

confidence: 99%

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A case of life-threatening intraoperative diffuse alveolar hemorrhage during a femur fracture operation with suspected fat embolism - A case report -

et al. 2018

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Diffuse alveolar hemorrhage (DAH) is a clinicopathological syndrome described by the accumulation of intra-alveolar red blood cells originating from alveolar capillaries [1,2]. DAH is a medical emergency that often results in acute respiratory failure [3,4]. Causes of DAH are diverse. It is known that trauma or a long bone fracture are associated with DAH [3,4]. To the best of our knowledge, this is the first case of DAH during long bone fracture operation reported in the literature. We report a case of life-threatening intraoperative DAH associated with a femur fracture operation. CASE REPORTA 73-year-old female (height, 163 cm and weight, 55 kg) was admitted to our hospital for a right distal femur fracture. Diffuse alveolar hemorrhage (DAH) is a rare manifestation of trauma or long bone fracture. A relationship between fat embolism and DAH has been reported. A 73-year-old female developed sudden cardiac arrest during a femur fracture operation. Cardiopulmonary resuscitation (CPR) was repeated for about 130 minutes. During CPR, blood was detected in the endotracheal tube. Diffuse patch ground glass opacity appearance and increased pulmonary artery with bulging of interventricular septum toward the left ventricle were detected on a chest computed tomography scan. After full supportive care including ventilator therapy, the patient's condition became stabilized and she was extubated after 7 days. We report a case of DAH in the course of a suspected fat embolism during femur fracture operation. Although DAH is a rare manifestation of fat embolism, early diagnosis and aggressive treatment likely can decrease morbidity and mortality.

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mentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…DAH is a medical emergency that often results in acute respiratory failure [3,4]. Causes of DAH are diverse.…”

mentioning

confidence: 99%

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A case of life-threatening intraoperative diffuse alveolar hemorrhage during a femur fracture operation with suspected fat embolism - A case report -

et al. 2018

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“…Dyspnoea, tachypnoea and hypoxaemia with chest radiograph showing fluffy lung infiltrates occur typically within 24–72 hours as signs of respiratory involvement 3. The occurrence of diffuse alveolar haemorrhage (DAH) in fat embolisms is very rare 4. Early initiation of prone position ventilation has significant benefits in patients with severe acute respiratory distress syndrome (ARDS)5 and is commonly used nowadays to enhance oxygenation by improving pulmonary function.…”

Section: Introductionmentioning

confidence: 99%

Prone positioning in a patient with fat embolism syndrome presenting as diffuse alveolar haemorrhage: new perspective

et al. 2020

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Diffuse alveolar haemorrhage (DAH) is a rare complication of fat embolism syndrome leading to severe hypoxaemia due to the effusion of blood into the alveoli from the damaged pulmonary microvasculature. The management is usually supportive with patients being nursed in supine position. The use of prone position ventilation in a DAH has rarely been reported before. We report an interesting case of a 26-year-old male patient diagnosed with DAH caused by fat embolism in whom prone position ventilation improved the lung dynamics and oxygenation.

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Fat emboli—Related diffuse alveolar haemorrhage (FEDAH) an acronym to remember—Case series

Williams,

Nair,

James

et al. 2023

Respirology Case Reports

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Fat embolism syndrome (FES) is a rare but potentially fatal complication of trauma or orthopaedic surgery, which presents predominantly with pulmonary symptoms. The rapid worsening respiratory failure in a previously normal orthopaedic surgery or trauma patients usually get evaluated for pulmonary embolism, fat‐embolism‐related acute respiratory distress or transfusion related acute lung injury. Orthopaedic surgeons and clinicians need to be aware of related entity termed ‘Fat Embolism related Diffuse Alveolar Haemorrhage’ (FEDAH). The clinical presentation in an orthopaedic surgery of trauma patient with FEDAH are haemoptysis, worsening type 1 respiratory failure and oxygen requirement, drop in haemoglobin levels with chest x‐ray/computed tomography suggestive of Diffuse alveolar haemorrhage (DAH). Early bronchoscopy and bronchoalveolar lavage (BAL) confirmation of DAH, presence of BAL haemosiderophages and lipid‐laden macrophages are the pointers in the early diagnosis of FEDAH. It needs a high clinical suspicion and interdepartmental collaborative measures. Timely referral from orthopaedic surgeons, early bronchoscopy and treatment with steroids is key in diagnosis and management.

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Diffuse Alveolar Hemorrhage: A Rare Manifestation of Trauma

Abstract: Combined FES and DAH can occur in association with orthopedic injury and repair and are likely an under-recognized entity.

Cited by 8 publications

References 0 publications

A case of life-threatening intraoperative diffuse alveolar hemorrhage during a femur fracture operation with suspected fat embolism - A case report -

A case of life-threatening intraoperative diffuse alveolar hemorrhage during a femur fracture operation with suspected fat embolism - A case report -

Prone positioning in a patient with fat embolism syndrome presenting as diffuse alveolar haemorrhage: new perspective

Fat emboli—Related diffuse alveolar haemorrhage (FEDAH) an acronym to remember—Case series

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