Fat embolism syndrome in a patient with a right undisplaced femoral neck fracture

Ishikawa, Junta; Sato, Nobuhiro; Ishigame, Naho; Ono, Ayaka; Yamagishi, Ikumi; Sakagami, Atsushi; Sakai, Yoshinori; Hirose, Yasuo; Yabe, Masahiro

doi:10.1093/ageing/afac046

Cited by 2 publications

(1 citation statement)

References 5 publications

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“…The possibility of fat embolism syndrome following trauma cannot be ruled out; however, it is extremely rare for respiratory function to deteriorate so rapidly with femoral neck or lumbar vertebral fractures. Additionally, the imaging indicates worsening pulmonary edema, which is not consistent with deterioration caused by fat embolism [ 10 ]. While respiratory status can deteriorate rapidly due to trauma-induced cytokines and lung damage from damage-associated molecular patterns, it is exceedingly rare for respiratory function to deteriorate so rapidly even with more severe trauma [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Acute Respiratory Distress Syndrome Following Non-thoracic Trauma in a Patient With Idiopathic Pulmonary Fibrosis

Hirooka,

Ota,

Torizawa

et al. 2024

Cureus

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A 72-year-old man with idiopathic pulmonary fibrosis (IPF) was on home oxygen therapy at 1 L/min. He fell approximately 3 m onto a concrete surface while painting the roof of his home and was emergently transported to a local hospital due to pain in his lower back and right lower limb. His initial Krebs von den Lungen level decreased with medical treatments but has shown an increasing trend over the past three respiratory outpatient visits. His other medical conditions, including dyslipidemia, lumbar pain, and allergic rhinitis, were treated with several drugs prescribed by a nearby clinic. At the previous hospital, an increased oxygen demand of around 5 L via mask was noted, although other vital signs were stable. A plain whole-body computed tomography (CT) scan revealed pulmonary edema, a fracture of the right femoral neck, and a fracture of the third lumbar vertebral body. During transfer to our hospital for surgery, crossing the Amagi Pass at an elevation of approximately 830 m, the patient's respiratory condition rapidly deteriorated. Upon arrival, the cardiac wall movement was hyperdynamic, and PaO 2 was 29 mmHg under supplemental oxygen at 15 L/min, necessitating oral endotracheal intubation and initiation of mechanical ventilation. A chest CT scan showed worsening diffuse ground-glass opacities in both lungs compared to the previous CT scan at the referring hospital. Despite positive pressure ventilation with the mechanical ventilator, the patient's condition did not improve, and he died in the emergency room. Acute respiratory distress syndrome (ARDS) can occur following severe trauma but the onset of ARDS due to moderate trauma is extremely rare. Considering the possibility of an acute exacerbation of IPF prior to the injury, this report discusses the possibility of developing ARDS due to trauma-induced cytokines and lung damage from damage-associated molecular patterns, the possibility of inhaling dust while working on the roof, pneumonia caused by prescribed medication, viral infections, exposure to pollen and/or high altitude while passing through the mountain pass, and hypoxemia-inducing pulmonary edema.

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Section: Discussionmentioning

confidence: 99%

A Case of Acute Respiratory Distress Syndrome Following Non-thoracic Trauma in a Patient With Idiopathic Pulmonary Fibrosis

Hirooka,

Ota,

Torizawa

et al. 2024

Cureus

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Visual disturbance and Purtscher’s retinopathy heralding an occult femoral fracture

Corbett,

Small,

Gale

2024

BMJ Case Rep

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An 80-year-old fit and active gentleman presented with left hip pain and a new central scotoma in his right eye after falling from an electric bicycle. He was able to mobilise independently and presented to ophthalmic services where cotton wool spots were found in both eyes and a presumptive diagnosis of Purtscher’s retinopathy (PuR) was made. The patient was referred to the emergency department for assessment of a potential fracture. The subcapital femoral neck fracture was subtle on X-ray and only detected the following day with radiological and orthopaedic review. Two screws were placed to stabilise the fracture with a good outcome for his hip and for his vision. PuR can be seen following trauma to the head, neck or chest, following long bone fracture and in renal failure or pancreatitis. Our case highlights how the non-specific finding of cotton wool spots becomes a highly specific diagnosis in the context of trauma and should lead to careful evaluation for fractures.

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Fat embolism syndrome in a patient with a right undisplaced femoral neck fracture

Cited by 2 publications

References 5 publications

A Case of Acute Respiratory Distress Syndrome Following Non-thoracic Trauma in a Patient With Idiopathic Pulmonary Fibrosis

A Case of Acute Respiratory Distress Syndrome Following Non-thoracic Trauma in a Patient With Idiopathic Pulmonary Fibrosis

Visual disturbance and Purtscher’s retinopathy heralding an occult femoral fracture

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