Ultrasonographic Findings in Fat Embolism Syndrome

Abstract

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.

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

“…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 ).…”

Bone marrow necrosis and fat embolism syndrome in sickle cell disease during COVID‐19 infection treated successfully with sequential red cell and plasma exchange

“…Emboli may be released into the venous circulation through disrupted venules and venous sinusoids and subsequently reach the systemic circulation through the pulmonary capillaries or a patent foramen ovale. Those such particles have been seen traversing through the inferior vena cava and right heart on echocardiography performed early in the course of the disease would appear supportive of this theory [ 6 ]. Alternatively, emboli may be a consequence of free fatty acid aggregation following trauma or illness.…”

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

“…Transthoracic and transesophageal echocardiography can detect fat emboli during orthopaedic surgery as hyperechoic particles in the cardiac cavities. 17 Ultrasonography has also been used to detect floating mobile hyperechoic spots in internal jugular veins of patients diagnosed with FES. 1 Transcranial Doppler (TCD) has been described as an interesting diagnostic tool, as it can detect MES caused by moving microemboli.…”