Transthoracic Echocardiography in Fat Embolism: A Real-Time Diagnostic Tool

Maghrebi, Sami; Cheikhrouhou, H.; Triki, Z.; Karoui, A.

doi:10.1053/j.jvca.2017.01.008

Cited by 6 publications

(3 citation statements)

References 4 publications

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“…3 Recent case reports have described that TTE can detect fat emboli, seen as flowing hyperechoic particles in IVC. 4 This image emphasizes the utility of TTE to diagnose FES.…”

Section: Cpc-em Capsulementioning

confidence: 92%

Ultrasonographic Findings in Fat Embolism Syndrome

Yonezaki¹,

Nagasaki²,

Kobayashi³

2021

Clinical Practice and Cases in Emergency Medicine

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Case Presentation: A 93-year-old man living in a nursing home presented to our emergency department with altered mental status. Examination revealed hypotension and severe hypoxia. Chest radiograph showed infiltrates in the right upper lobe, and computed tomography of the abdomen and pelvis demonstrated a left femoral neck fracture. A point-of-care transthoracic echocardiogram (TTE) revealed an enlarged right ventricle, severe tricuspid regurgitation, and numerous white floating dots moving toward the right atrium from the inferior vena cava (IVC), leading to the diagnosis of fat embolism syndrome (FES). Discussion: Although imaging studies can facilitate diagnosis, the diagnosis of FES is typically made by clinical history and presentation, making a swift diagnosis often difficult in those who are critically ill. Recent case reports have described that TTE can detect fat emboli, seen as flowing hyperechoic particles in IVC. This image demonstrates the utility of TTE to diagnose FES.

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“…3 Recent case reports have described that TTE can detect fat emboli, seen as flowing hyperechoic particles in IVC. 4 This image emphasizes the utility of TTE to diagnose FES.…”

Section: Cpc-em Capsulementioning

confidence: 92%

Ultrasonographic Findings in Fat Embolism Syndrome

Yonezaki¹,

Nagasaki²,

Kobayashi³

2021

Clinical Practice and Cases in Emergency Medicine

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“…Perioperative TEE detected emboli on the right side of the heart but not the left, contrary to postmortem findings of systemic emboli. TEE detects right-sided emboli during orthopaedic surgery with high sensitivity 23 , 25 , 26 , 37 , 38 and such findings may predict clinical deterioration 23 , 24 .…”

Section: Discussionmentioning

confidence: 99%

Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brain

Kristiansen,

Jarmund,

Hilmo

et al. 2024

JBJS Open Access

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Background: Shaft fractures of the femur are commonly treated with intramedullary nailing, which can release bone marrow emboli into the bloodstream. Emboli can travel to the lungs, impairing gas exchange and causing inflammation. Occasionally, emboli traverse from the pulmonary to the systemic circulation, hindering perfusion and resulting in injuries such as heart and brain infarctions, known as fat embolism syndrome. We studied the extent of systemic bone marrow embolization in a pig model. Methods: Twelve anesthetized pigs underwent bilateral intramedullary nailing of the femur, while 3 animals served as sham controls. Monitoring included transesophageal echocardiography (TEE), pulse oximetry, electrocardiography, arterial blood pressure measurement, and blood gas and troponin-I analysis. After surgery, animals were monitored for 240 minutes before euthanasia. Post mortem, the heart, lungs, and brain were biopsied. Results: Bone marrow emboli were found in the heart and lungs of all 12 of the pigs that underwent intramedullary nailing and in the brains of 11 of them. No emboli were found in the sham group. The pigs subjected to intramedullary nailing exhibited significant hypoxia (PaO2/FiO2 ratio, 410 mm Hg [95% confidence interval (CI), 310 to 510) compared with the sham group (594 mm Hg [95% CI, 528 to 660]). The nailing group exhibited ST-segment alterations consistent with myocardial ischemia and a significant increase in the troponin-I level compared with the sham group (1,580 ng/L [95% CI, 0 to 3,456] versus 241 ng/L [95% CI, 0 to 625] at the 240-minute time point; p = 0.005). TEE detected emboli in the right ventricular outflow tract, but not systemically, in the nailing group. Conclusions: Bilateral intramedullary nailing caused bone marrow emboli in the lungs and systemic emboli in the heart and brain in this pig model. The observed clinical manifestations were consistent with coronary and pulmonary emboli. TEE detected pulmonary but not systemic embolization. Clinical Relevance: Femoral intramedullary nailing in humans is likely to result in embolization as described in our pig model. Focused monitoring is necessary for detection of fat embolism syndrome. Absence of visual emboli in the left ventricle on TEE does not exclude the occurrence of systemic bone marrow emboli.

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“…A X ray or CT scan of the chest can show no abnormalities like in our case report or show non-specifics abnormalities like bilateral diffuse infiltrates and pulmonary oedema ( 18 ). Transoesophageal and transthoracic ultrasound of the heart have been used to detect fat emboli ( 16 , 19 ). Our ultrasound images ( Figure 1 ) are very similar to the images shown in case reports ( 20 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

Fat embolism syndrome in a patient that sustained a femoral neck fracture: A case report

2022

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BackgroundWe present a case of a patient with a femoral neck fracture that shows neurological impairment and respiratory distress 1 day after trauma, caused by the Fat Embolism Syndrome with the presence of Cerebral Fat Embolisms.Case summaryA 75 year old female remained unresponsive after a hemi arthroplasty was performed because of a 1 day old femoral neck fracture. She rapidly developed respiratory insufficiency and an obstructive shock with right ventricle dilatation on transthoracic echocardiography. The diffusion-weighted MRI brain images showed the “Starfield” pattern, a radiologic phenomenon typical for FES. During 3 weeks of ICU admission the neurologic state slowly ameliorated.ConclusionThe rare FES is a clinical diagnosis with mainly respiratory, neurologic and dermatologic symptoms in the setting of a trauma patient. Fat embolisms are able to reach the brain without the presence of a patent foramen ovale to cause neurological symptoms. Diagnosing FES remains challenging but the distinctive “Starfield” pattern on MRI scans is promising.

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Transthoracic Echocardiography in Fat Embolism: A Real-Time Diagnostic Tool

Cited by 6 publications

References 4 publications

Ultrasonographic Findings in Fat Embolism Syndrome

Ultrasonographic Findings in Fat Embolism Syndrome

Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brain

Fat embolism syndrome in a patient that sustained a femoral neck fracture: A case report

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