The Fulminant Fat Embolism Syndrome

Abstract

The fulminant form of the fat embolism syndrome is a rare though often fatal complication of injury. Little discussion but much controversy surrounds the subject despite it being of considerable interest to all those managing the early phase of trauma. Recognised presentations of this condition are the fulminating onset, soon after injury, of acute cor pulmonale, respiratory failure and embolic neurological phenomena. I This report describes five cases of the fulminant fat embolism syndrome seen over a period of eight years. Case 1 A 53-year-old man was admitted with a comminuted compound fracture of the tibia and fibula. He was conscious, with a blood pressure of 120/80 mmHg and pulse rate of 90/min. There was no continuing massive blood loss on admission and he was given Stable Plasma Protein Solution 500 ml intravenously. Because he began bleeding profusely from the site of injury an arterial tourniquet was applied and SPPS 500 ml whole blood 1,500 ml and crystalloid solution 2,000 ml given to combat shock. Three and a half hours after injury he was anaesthetised for amputation of the leg. Fifteen

Fat embolism syndrome: State-of-the-art review focused on pulmonary imaging findings

“…In most cases, fulminant FES present with severe respiratory distress symptoms. It often develops in the first 12 h after surgery, a phenomenon likely related to high burden and larger size of emboli resulting in acute pulmonary hypertension and right heart failure [21,22]. The high pulmonary arterial pressure displaces fat droplets across the pulmonary capillary bed, shunting them into the systemic circulation which may lead to cerebral fat embolism manifesting as confusion and loss of consciousness [23].…”

Fat embolism--a review.

“…This is typical of the majority of described cases (Hagley, 1983), however, with modern investigative techniques, and a greater awareness of the condition, it should become more common to diagnose the syndrome earlier, excluding other possible causes of the symptoms.…”

“…A C.T. scan coupled with the clinical picture, may be able to differentiate primary intracranial injury from embolic neurological changes, and a Swan-Ganz Catheter can differentiate hypovolaemic shock from acute cor pulmonale using estimation of right atrial and pulmonary wedge pressures (Hagley, 1983). An ECG may suggest acute cor pulmonale or myocardial ischaemia, arterial blood gases estimation will show hypoxia and a normal or low PaCO2, and there may be abnormal coagulation studies.…”

Unexpected Neurological Sequelae following Cerebral Fat Embolism Syndrome

“…The presentation of fat embolism syndrome can vary from mild to fulminant lethal form. Fulminant fat embolism syndrome is caused by sudden intravascular obstruction of pulmonary vasculature by fat globules and leading to right heart failure, shock and also death within the first 1-12 hours of injury and milder forms of fat embolism syndrome may go undetected clinically [13,14].…”