Multimodal imaging tools for diagnosis of fat embolism

Shobha, Nandavar; Bermejo, Pablo García; Bhatia, Rohit; Choi, Young-Bin; Smith, Eric E.; Demchuk, Andrew M.

doi:10.4103/0974-2700.82232

Cited by 3 publications

(3 citation statements)

References 11 publications

(14 reference statements)

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“…[1525] Isolated case report suggests microemboli detected by Trans Cranial Doppler (TCD) and Magnetic Resonance Imaging (MRI) can add in diagnosing FES. [626–28]…”

Section: Discussionmentioning

confidence: 99%

Alveolar hemorrhage in a case of fat embolism syndrome: A case report with short systemic review

et al. 2013

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Fat embolism and fat embolism syndrome (FES) are well-known complications of long bone fracture and surgery involving manipulation of skeletal elements. Many non-traumatic causes of FES have been suggested but they constitute only a small portion. FES presents with classical symptoms of petechiae, hypoxemia, central nervous system symptoms along with other features such as tachycardia and pyrexia. Diagnosis of FES relies on clinical judgment rather than objective findings such as emboli present in the retinal vessels on fundoscopy, fat globules present in urine and sputum, a sudden inexplicable drop in hematocrit or platelet values, increasing erythrocyte sedimentation rate.

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“…[1525] Isolated case report suggests microemboli detected by Trans Cranial Doppler (TCD) and Magnetic Resonance Imaging (MRI) can add in diagnosing FES. [626–28]…”

Section: Discussionmentioning

confidence: 99%

Alveolar hemorrhage in a case of fat embolism syndrome: A case report with short systemic review

et al. 2013

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“…MES are characterized by large-amplitude, unidirectional, transient signals lasting less than 300 ms, with a chirping or clicking sound. 18 Forteza et al showed that TCD detection of MES after long bone fractures can be a useful diagnostic tool with both prognostic and predictive value for FES. 19 In the case of total hip replacement, an ultrasound flowmeter based on the Doppler principle was used by Herndon et al to detect fat emboli, estimating the amount and timing of emboli during surgery through audible squeaks.…”

Section: Discussionmentioning

confidence: 99%

“…Transcranial Doppler (TCD) has been described as an interesting diagnostic tool, as it can detect MES caused by moving microemboli. MES are characterized by large‐amplitude, unidirectional, transient signals lasting less than 300 ms, with a chirping or clicking sound 18 . Forteza et al showed that TCD detection of MES after long bone fractures can be a useful diagnostic tool with both prognostic and predictive value for FES 19 .…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of fat embolism syndrome using point‐of‐care ultrasound

Cheong,

Avanzato,

Gómez

et al. 2023

Sonography

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Fat embolism (FES) is a condition that can lead to severe organ effects and death in patients with long bone fractures. Diagnosis is challenging due to multiple criteria. This case report presents the use of point‐of‐care ultrasound (POCUS) in diagnosing right ventricular dysfunction associated with fat embolism syndrome. A 36‐year‐old patient with a history of obesity presented with multiple fractures and respiratory failure after a road accident. Bedside echocardiography showed evidence of dilated right chambers, right ventricular outflow tract shortened acceleration time, and mild tricuspid insufficiency. Venous ultrasonography showed microembolic signals (MES) interpreted as fat embolism. The patient was treated with fracture reduction and osteosynthesis, which showed improvement in right ventricular dysfunction and the disappearance of MES. FES is a clinical syndrome that occurs after an identifiable bone injury. This case highlights the utility of POCUS in the diagnosis of FES.

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Microbleeds show a characteristic distribution in cerebral fat embolism

et al. 2021

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This systematic review aims to test the hypothesis that microbleeds detected by MRI are common and show a characteristic pattern in cerebral fat embolism (CFE). Eighty-four papers involving 140 CFE patients were eligible for this review based on a systematic literature search up to 31 January 2020. An additional case was added from hospital records. Patient data were individually scrutinised to extract epidemiological, clinical and imaging variables. Characteristic CFE microbleed pattern resembling a “walnut kernel” was defined as punctuate hypointensities of monotonous size, diffusely located in the subcortical white matter, the internal capsule and the corpus callosum, with mostly spared corona radiata and non-subcortical centrum semiovale, detected by susceptibility- or T2* weighted imaging. The presence rate of this pattern and other, previously described MRI markers of CFE such as the starfield pattern and further diffusion abnormalities were recorded and statistically compared. The presence rate of microbleeds of any pattern, the “walnut kernel microbleed pattern”, diffusion abnormality of any pattern, the starfield pattern, and cytotoxic edema in the corpus callosum was found to be 98.11%, 89.74%, 97.64%, 68.5%, and 77.27% respectively. The presence rate between the walnut kernel and the starfield pattern was significantly (p < 0.05) different. Microbleeds are common and mostly occur in a characteristic pattern resembling a “walnut kernel” in the CFE MRI literature. Microbleeds of this pattern in SWI or T2* MRI, along with the starfield pattern in diffusion imaging appear to be the most important imaging markers of CFE and may aid the diagnosis in clinically equivocal cases.

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Multimodal imaging tools for diagnosis of fat embolism

Cited by 3 publications

References 11 publications

Alveolar hemorrhage in a case of fat embolism syndrome: A case report with short systemic review

Alveolar hemorrhage in a case of fat embolism syndrome: A case report with short systemic review

Diagnosis of fat embolism syndrome using point‐of‐care ultrasound

Microbleeds show a characteristic distribution in cerebral fat embolism

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