&lt;p&gt;Histopathological evaluation of autopsy cases with isolated pulmonary fat embolism (IPFE): is cardiopulmonary resuscitation a main cause of death in IPFE?&lt;/p&gt;

E, Turkmen Samdanci; Çelik, Muhammet Reha; Pehlivan, Sultan; Çelbiş, Osman; Türkkan, Dilhan; Kara, Dogus Ozdemir; Pamukçu, Esra

doi:10.2147/oaem.s194340

Cited by 12 publications

(8 citation statements)

References 28 publications

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“…According to the literature, PFE after CPR related to rib fractures is usually mild (score 1 of Falzi) and not considered a factor that can limit the effectiveness of the resuscitation [ 6 , 7 ]. However, in our study, we detected an important PFE (score 2 of Falzi) in about 30% of children that received an intraosseous infusion.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies showed that PFE can also be found without bone fractures, in cases with corticosteroid treatment, fatty liver, diabetes, osteomyelitis, burns, liposuction, cardiopulmonary bypass surgery, decompression sickness, parenteral lipid infusion, hemorrhagic pancreatitis, carbon tetrachloride poisoning, massive hepatic necrosis with fatty liver, heat exposure, and sickle-cell disease or in cases of diffuse soft tissue contusions [ 2 – 5 ]. In the end, it is known that PFE can be detected after cardio-pulmonary resuscitation (CPR) by external cardiac massage with rib cage fractures [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Fat embolism after intraosseous catheters in pediatric forensic autopsies

2022

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In our center, we performed the autopsy of a child who died from drowning and presented, at autopsy, a major pulmonary fat embolism (PFE). A cardiopulmonary resuscitation (CPR) was performed, including infusion by intraosseous catheter (IIC). No other traumatic lesions and diseases classically related to a risk of PFE were detected. According to some animal studies, we considered the IIC as the only possible cause for PFE. However, we could not find literature to confirm this hypothesis in humans, especially in a pediatric population. To verify the occurrence of PFE after IIC in a pediatric population, we retrospectively selected 20 cases of pediatric deaths autopsied in our center, in which a CPR was performed, without bone fractures or other possible causes of PFE: 13 cases with IIC (group A) and 7 cases without IIC (group B). Several exclusion criteria were considered. The histology slides of the pulmonary tissue were stained by Oil Red O. PFE was classified according to the Falzi scoring system. In group A, 8 cases showed PFE: 4 cases with a score 1 of Falzi and 4 cases with a score 2 of Falzi. In group B, no case showed PFE. The difference between the two groups was statistically significant. The results of our study seem to confirm that IIC can lead to PFE in a pediatric population and show that the PFE after IIC can be important (up to score 2 of Falzi). To the best of our knowledge, our study is the first specifically focused on the occurrence of PFE after IIC in a pediatric population by using autoptic data.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fat embolism after intraosseous catheters in pediatric forensic autopsies

2022

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“…Eriksson and colleagues found pulmonary fat embolism in 7 of 10 patients who had cardiopulmonary resuscitation (CPR) but no trauma (7). Samdanci and colleagues found isolated pulmonary fat embolism in 402 of 4118 autopsied cases (52). They graded fat embolism from 1 to 3 based upon Scully and Glass and modified by Mudd and colleagues (49).…”

Section: Discussionmentioning

confidence: 99%

Fat Embolism, Fat Embolism Syndrome and the Autopsy

Milroy¹,

Parai²

2019

Academic Forensic Pathology

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Fat embolism is common following trauma and is a common autopsy finding in these cases. It may also be seen in non-traumatic cases and is seen in children as well as adults. In comparison fat embolism syndrome (FES) only occurs in a small number of trauma and non-trauma cases. Clinical diagnosis is based on characteristic clinical and laboratory findings. Fat embolism exerts its effect by mechanical blockage of vessels and/or by biochemical means including breakdown of fat to free fatty acids causing an inflammatory response. Fat embolism can be identified at autopsy on microscopy of the lungs using fat stains conducted on frozen tissue, including on formalin fixed but not processed tissue. With FES fat emboli can be seen in other organs including the brain, kidney and myocardium. Fat can also be identified with post-fixation staining, typically with osmium tetroxide. Scoring systems have been developed to try and determine the severity of fat embolism in lung tissue. Fat embolism is also common following resuscitation. When no resuscitation has taken place, the presence of fat on lung histology has been used as proof of vitality. Diagnosis of fat embolism syndrome at autopsy requires analysis of the history, clinical and laboratory findings along with autopsy investigations to determine its relevance, but is an important diagnosis to make which is not always identified clinically. This paper reviews the history, clinical and laboratory findings and diagnosis of fat embolism and fat embolism syndrome at autopsy.

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“…In addition, other medical-related cases, such as liposuction and fat transplantation in cosmetic surgery, cardiopulmonary bypass, pancreatitis, joint repair, severe burns, sickle cell anemia, and intravenous lipid transfusion, can also cause fat embolism syndrome [12] [13] . Recent studies have also revealed that autologous blood transfusion during orthopedic surgery and cardiopulmonary resuscitation (with rib fractures) can lead to fat embolism [14][15][16] [17] .…”

Section: Clinical Morbidity and Mortality Of Fesmentioning

confidence: 99%

“…Therefore, grade ⅲ and above fat embolism could be considered as absolutely fatal injury. Samdanci et al [14] also used similar histopathological methods to study the histology of microscopic fat embolism. They classified the histology of microscopic fat embolism into: (1) Grade I: no fat droplets were observed at low magnification (4×); (2) Grade II: 2~5 lipid droplets were observed under 10× microscope;…”

Section: Clinical Diagnostic Criteria and Pathological Gradingmentioning

confidence: 99%

Fatal Pulmonary Fat Embolism Occurring in Lumbar Spinal Fusion Surgery: Case Report and Review of Literature

Zhang¹,

Zhang²,

Cheng³

et al. 2021

JCMR

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Fat embolism system is one of the serious complications of orthopedic surgery, which is common seen in cases of severe trauma with long bone fractures. However, in clinical medical practice, it is rarely seen for Fat embolism system in orthopaedic lumbar fusion surgery. This paper report a case of sudden shock and death during lumbar fusion due to lumbar intervertebral disc disease. By forensic pathological examination, the pulmonary and brain fat embolism were observed in tissue sections, and the patient was diagnosed as FES. Based on the review of relevant literature and the pathological findings of this case, the clinical characteristics, diagnosis and treatment of FES in lumbar fusion are commentated in this paper. At the same time, it is emphasized that the clinical practise should strengthened the understanding and attention of non-traumatic fat embolism cases in order to timely identify, diagnose and treat the disease, improve the effectiveness of treatment, and reduce the corresponding medical disputes.

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<p>Histopathological evaluation of autopsy cases with isolated pulmonary fat embolism (IPFE): is cardiopulmonary resuscitation a main cause of death in IPFE?</p>

Cited by 12 publications

References 28 publications

Fat embolism after intraosseous catheters in pediatric forensic autopsies

Fat embolism after intraosseous catheters in pediatric forensic autopsies

Fat Embolism, Fat Embolism Syndrome and the Autopsy

Fatal Pulmonary Fat Embolism Occurring in Lumbar Spinal Fusion Surgery: Case Report and Review of Literature

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