Duplex ultrasound evidence of fat embolism syndrome

Naddaf, Abdallah; Andre, Jason; Bly, Stanley J.; Hood, Douglas B.; Hodgson, Kim J.; Desai, Sapan S.

doi:10.1016/j.jvscit.2016.08.001

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…Incidentally, both were noted to have hyperechoic masses consistent with fat emboli. Although neither were showing signs or symptoms of FES, they were deemed high risk, and transferred to the intensive care unit for continuous pulse oximetry and cardiac monitoring 16. Ultimately, these cases highlight that when venous fat emboli are identified on imaging following trauma, whether it be CT or ultrasound, medical management should adjust in anticipation of possible FES.…”

Section: Discussionmentioning

confidence: 98%

Cerebral fat embolism syndrome (FES): similar cases with different outcomes

Jorgensen¹,

Bashir

Satpathy

2018

BMJ Case Reports

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Fat embolism syndrome (FES) is a rare multisystem, clinical syndrome occurring in 0.9%–2.2% of long-bone fractures. The severity of FES can vary from subclinical with mild respiratory changes and haematological aberrations to a fulminant state characterised by sudden onset of severe respiratory and neurological impairment. Here we present two patients with cerebral FES secondary to femur fracture. Both patients exhibited profound neurological impairment with varied outcomes. Our cases highlight the importance of a high clinical suspicion of FES in patients with long-bone fractures and neurological deterioration. We recommend early plate osteosynthesis to prevent additional emboli in patients with FES and situational placement of intracranial pressure monitoring. Finally, cerebral FES has low mortality even in a patient with tentorial herniation and fixed, dilated pupils.

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Section: Discussionmentioning

confidence: 98%

Cerebral fat embolism syndrome (FES): similar cases with different outcomes

Jorgensen¹,

Bashir

Satpathy

2018

BMJ Case Reports

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“…Fat embolus should be visible on ultrasound as a hyperechoic intraluminal lesion or small hyperechoic foci, and may be mobile [5 , 6 , 22] . Grayscale images should be analyzed carefully, as many of the sonographic criteria used to diagnose a DVT may be not be met by a fat embolus, including lack of compressibility, spontaneity, phasicity, and augmentation [23] . Negative duplex ultrasound 3 days after surgery in our case may be due to migration or fragmentation of the fat embolism previously seen on CT, and a negative test is therefore of limited value.…”

Section: Discussionmentioning

confidence: 99%

Fat embolism in the popliteal vein detected on CT: Case report and review of the literature

Burr

Chaudhry

Zhang

et al. 2020

Radiology Case Reports

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Fat emboli are a common phenomenon, but are rarely detected or reported on extremity CT imaging. We present a case of fat embolus in the popliteal vein in the setting of a femoral fracture. This is the most distal fat embolus described in the literature. There are no guidelines regarding intervention if a fat embolus is detected in a peripheral vein on CT. A review of all the previous cases of peripheral fat emboli is presented for reference.

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“…The improvement of the quality of transthoracic echocardiography nowadays makes it a useful tool to assess for fat emboli in the circulation and heart of patients with long bone fractures as demonstrated in multiple case reports [9–11]. Fat emboli had been described as mobile, echogenic intraluminal mass in vessels [9] and “snowstorm”-like appearance in the chambers of the heart [10].…”

Section: Discussionmentioning

confidence: 99%

“…Fat emboli had been described as mobile, echogenic intraluminal mass in vessels [9] and “snowstorm”-like appearance in the chambers of the heart [10]. Fat emboli are usually spherical in shape, non-obstructive and show phasic flow with breathing [11]. This can be distinguished from a thrombus which adheres to the vein wall leading to a non-compressible vein and non-phasic flow with breathing.…”

Section: Discussionmentioning

confidence: 99%

Fat embolism in right internal jugular vein: incidental ultrasound finding during internal jugular vein cannulation

Adi¹,

Fong²,

Azil³

et al. 2019

Ultrasound J

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Background We report a case study of fat embolism seen on ultrasound at right internal jugular vein during central venous cannulation in a patient diagnosed with fat embolism syndrome. This case demonstrates the importance of ultrasound for evaluation of trauma cases with suspicion of fat embolism. Case presentation A 23-year-old trauma patient with closed fracture of left femoral shaft and left humerus presented to our emergency department (ED). 11 h after admission to ED, patient became confused, hypoxic and hypotensive. He was then intubated for respiratory failure and mechanically ventilated. Transesophageal ultrasound revealed hyperdynamic heart, dilated right ventricle with no regional wall abnormalities and no major aorta injuries. Whole-body computed tomography was normal. During central venous cannulation of right internal jugular vein (IJV), we found free floating mobile hyperechoic spots, located at the anterior part of the vein. A diagnosis of fat embolism syndrome later was made based on the clinical presentation of long bone fractures and fat globulin in the blood. Despite aggressive fluid resuscitation, patient was a non-responder and needed vasopressor infusion for persistent shock. Blood aspirated during cannulation from the IJV revealed a fat globule. Patient underwent uneventful orthopedic procedures and was discharged well on day 5 of admission. Conclusions Point-of-care ultrasound findings of fat embolism in central vein can facilitate and increase the suspicion of fat embolism syndrome. Electronic supplementary material The online version of this article (10.1186/s13089-019-0116-9) contains supplementary material, which is available to authorized users.

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Duplex ultrasound evidence of fat embolism syndrome

Cited by 5 publications

References 11 publications

Cerebral fat embolism syndrome (FES): similar cases with different outcomes

Cerebral fat embolism syndrome (FES): similar cases with different outcomes

Fat embolism in the popliteal vein detected on CT: Case report and review of the literature

Fat embolism in right internal jugular vein: incidental ultrasound finding during internal jugular vein cannulation

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