Fat embolism syndrome: What have we learned over the years?

Abstract

Although its original clinical description dates from the nineteenth century, fat embolism syndrome remains a diagnostic challenge for clinicians. Fat emboli occur in all patients with long-bone fractures, but only few of them develop a multisystem disorder affecting the lung, brain, and skin, also known as fat embolism syndrome (FES). The incidence of FES varies and is often underestimated. Mechanical and biochemical theories have been proposed for the pathophysiology of FES. Clinical manifestations consist of respiratory and cerebral dysfunction and a petechial rash. Diagnosis of FES is difficult and based mainly on clinical criteria. FES is a self-limiting disease and treatment needs to be mainly supportive. Surgical treatment of the coexistent injuries is still obscured by controversies and the treatment methods used provide inconclusive results. In this context, prevention focuses on the early identification of predisposing factors.

Fat Embolism Syndrome Without Objective Evidence of Bone or Soft Tissue Injury

“…Bed side echocardiography did not reveal cardiac failure. Applying modified Gurd'sand Wilson criteria 7,8 ( Table 1) for fat embolism syndrome(FES), it was found that present case satisfied 3 major criteria and 4 minor criteria required for diagnosis. On applying Schonfeld's criteria 9 (Table 2), which has more respiratory features, total scorewas 10 (> 5 is required for diagnosis of fat embolism syndrome).…”

“…There were also no evidence of injury or bleeding from any intra-abdominal site. Landmark work of Gurd and Wilson 3,11 provided diagnostic criteria for fat embolism syndrome, which has been subsequently modified 7,8 and applied to our patient. Diagnostic criteria given by Schonfeld's had score of 10, which further supported our diagnosis.…”

“…Diagnostic criteria given by Schonfeld's had score of 10, which further supported our diagnosis. 9 On application of modified Gurd and Wilson criteria, 7,8 (Table 1) it was found that three major criteria of hypoxemia, central nervous system depression disproportionate to hypoxemia and pulmonary oedema, along with four minor criteria of tachycardia, pyrexia, oliguria and thrombocytopenia were present. Schonfeld's criteria (Table 2), with more respiratory features, included symptoms and signs of diffuse pulmonary infiltrates on chest radiography, tachycardia, tachypnoea, hypoxemia and fever, amounting to diagnostic score of 10.…”

Fat Embolism Syndrome in Sickle Cell β-Thalassemia Patient With Osteonecrosis: An Uncommon Presentation in a Young Adult

“…Several clinic criteria for diagnosing FES, but the most relevant in our case are Gurd and Wilson’s criteria established in 1974 ( Table 4 ). 4 , 5 An additional sign which is very specific for FES is a brain MRI showing multiple microemboli in the white matter. 6 Our patient had acute hypoxic respiratory failure requiring intubation, acute encephalopathy, fever 40 °C, sudden thrombocytopenia, tachycardia, and MRI of the brain revealed extensive punctate ischemic infarcts in the white matter of both hemispheres.…”

Fat embolism syndrome: Case report of a clinical conundrum

“…It has been adapted many times since then. Modified Gurd and Wilson's criteria[ 2 8 ] requires at least one major and at least four minor signs for diagnosis [ Table 1 ]. Schonfeld et al .,[ 9 ] incorporated assessment of oxygenation with ABG in their scoring system [ Table 2 ].…”