|
| |
 |
|
| SYMPOSIUM: EMBOLISM IN THE INTENSIVE CARE UNIT |
|
| Year : 2013 | Volume
: 3
| Issue : 1 | Page : 64-68 |
|
Fat embolism syndrome
Michael E Kwiatt, Mark J Seamon
Department of Surgery, Cooper University Hospital, Division of Trauma Surgery, Camden, NJ, USA
| Date of Web Publication | 22-Mar-2013 |
Correspondence Address:
Michael E Kwiatt
Department of Surgery, Cooper University Hospital, Office of Surgical Education, 3 Cooper Plaza, Suite 411, Camden, NJ
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2229-5151.109426
 Abstract | | |
Fat embolism syndrome (FES) is an ill-defined clinical entity that arises from the systemic manifestations of fat emboli within the microcirculation. Embolized fat within capillary beds cause direct tissue damage as well as induce a systemic inflammatory response resulting in pulmonary, cutaneous, neurological, and retinal symptoms. This is most commonly seen following orthopedic trauma; however, patients with many clinical conditions including bone marrow transplant, pancreatitis, and following liposuction. No definitive diagnostic criteria or tests have been developed, making the diagnosis of FES difficult. While treatment for FES is largely supportive, early operative fixation of long bone fractures decreases the likelihood of a patient developing FES. Keywords: Fat embolism, fat embolism syndrome, trauma
How to cite this article:
Kwiatt ME, Seamon MJ. Fat embolism syndrome. Int J Crit Illn Inj Sci 2013;3:64-8 |
| Overview | |  |
Over 150 years ago, Zenker described the first case of fat embolism syndrome (FES) in a patient suffering from crush injury. [1] While FES was later clinically diagnosed and often reported in the literature over the next 100 years, Gurd's clinical description of the FES renewed interest in studying this syndrome. [2],[3]
Fat embolism is the presence of fat particles within the microcirculation, while FES is the systemic manifestation of fat emboli within the microcirculation. Common systemic manifestations include respiratory distress, altered mental status, and a rash.
FES is most often associated with orthopedic trauma. Rare cases of FES have been reported to occur following bone marrow transplantation, osteomyelitis, pancreatitis, alcoholic fatty liver, and even liposuction. [4] Since most cases of FES occur following orthopedic trauma, available research focused on FES in orthopedic trauma patients.
| Epidemiology | | |
Fat embolization occurs frequently following orthopedic trauma. Fat globules have been detected in the blood of 67% of orthopedic trauma patients in one study. [5] This number increased to 95% when the blood is sampled in close proximity to the fracture site. [6]
Hypoxemia may suggest fat embolization causing subclinical FES. Almost all patients monitored with continuous pulse oximetry following a long-bone fracture will have episodes of hypoxemia. [7]
Further embolization may occur during operative fixation. Intraoperative transesophageal echocardiogram studies have detected fat embolization in 41% of patients during the fixation of long-bone fractures. [8]
While almost all patients will have fat globules detected in the blood or develop transient hypoxia, the incidence of FES is much lower. In his initial study defining the clinical criteria for FES, Gurd reported the incidence of FES as 19% in a group of trauma patients. [9] As early operative fixation of long-bone fractures has become standard care, modern studies report an incidence of FES between 0.9% and 11%. [10],[11],[12]
| Pathophysiology | | |
Fat particles enter the circulation and cause damage to capillary beds. While the pulmonary system is most frequently affected, fat embolism can occur in the microcirculation of the brain, skin, eyes, and heart can be involved.
The two leading theories for the formation of fat embolism are the mechanical theory and biochemical theory. The mechanical theory proposes that obstruction of the systemic vasculature by fat embolism occurs from the direct release of bone marrow into the venous system following trauma. An elevated intramedullary pressure following trauma leads to the release of fat through open venous sinusoids. The embolized fat obstructs capillary beds. While this accounts for embolisms within the pulmonary capillaries, the theory does not explain embolisms within the systemic capillaries beds. Patients have been shown to have systemic fat embolization without a patent foramen ovale. [13]
The biochemical theory provides an alternate explanation for fat embolization. This theory proposes that the inflammatory response to trauma causes the release of free fatty acids from the bone marrow into the venous system. The elevated free fatty acids as well as the inflammatory mediators cause damage to capillary beds. Elevated free fatty acid levels have been associated with hypoxemia. [14] Free fatty acids have also been shown to induce inflammation within the lungs. [15]
Regardless of the mechanism initiating fat embolism, the end result is an intense inflammatory response. Capillary beds develop increased permeability and inflammatory mediators damage surrounding tissues. In the lungs, this induces lung injury that is indistinguishable from ARDS.
| Clinical Presentation | | |
Embolized fat droplets can travel to microvasculature throughout the body. FES is, therefore, a multiorgan disease and can damage any microcirculatory system within the body. Fat has been reported to embolize to the lungs, brain, skin, retina, kidneys, liver, and even the heart. [16]
Presenting signs are nonspecific and include tachypnea, tachycardia, and fever. Patient may have a petechial rash. Specific symptoms are dependent on the organ systems involved.
The pulmonary circulation is most commonly affected in FES, with up to 75% of patients experiencing respiratory depression. [17],[18] The degree of respiratory dysfunction can range from mild hypoxia requiring supplemental oxygen to ARDS requiring prolonged mechanical ventilation. Patients may decompensate rapidly to respiratory failure, especially during manipulation of fractures whilemoving the patient or setting the fracture in the operating room. This must especially be taken into consideration while in the operating room; an anesthetized patient may develop acute hypoxia secondary to FES.
FES can cause nonspecific neurological symptoms. Symptoms are believed to arise from cerebral edema rather than ischemia, so symptoms are nonlateralizing. [19] Patients may become lethargic or restless. A change in Glasgow coma scale (GCS) may suggest the development of cerebral edema due to FES. In the setting of severe cerebral edema the patient may become unresponsive. [20]
Dermal involvement results in a petechial rash, reported in approximately 50% of patients. [21] This rash tends to be transient, lasting less than 24 h. While the torso is most commonly affected, the entire dermis and even mucosal membranes can be involved.
Microvascular injury of the retina results in hemorrhagic lesion of the retina, seen in 50% of patients. [22] These lesions are self-limited, disappearing within weeks. [23] Residual visual deficits are uncommon.
Patients may also develop thrombocytopenia or a decrease in hemoglobin in FES.
| Diagnosis | | |
Since FES is a heterogeneous disease with no pathognomonic features, its diagnosis can be challenging. Gurd proposed a of clinical criteria for diagnosing FES in 1970 that he later modified with Wilson [4],[5] [Table 1]. Schonfeld has suggested a scoring system to helpin diagnosis[24][Table 2], while Lindeque proposed that FES can be diagnosed based on respiratory changes alone[25] [Table 3]. None of these criteria have been validated or have been universally accepted.
In the acute setting respiratory distress is the most clinically significant feature of FES. Respiratory distress from FES is indistinguishable from ARDS seen in polytrauma patients. White has suggested defining FES as ARDS with additional organ involvement due to bone trauma.[26]
Laboratory and imaging tests can helpin the diagnosis, but are nonspecific. Patients will demonstrate hypoxemia while on room air on arterial blood gas. Chest x-ray will often show diffuse interstitial infiltrates while chest CT scan will show diffuse areas of vascular congestion and pulmonary edema.
Attempts at developing specific test for FES have been disappointing. Biologic markers such as lipase, free fatty acids, and phospholipase A2 have all been shown to be elevated in patients with FES; however, this elevation is nonspecific in patients with lung injury. Microscopic examination of blood, urine, or sputum may show fat globules, but again this finding is nonspecific.
Bronchoalveolar lavage (BAL) has been heavily investigated as a diagnostic tool for FES.[27],[28],[29] Lipid inclusions within macrophages can be quantified BAL. BAL though is invasive and time intensive. It has not become widely used in diagnosing FES.
With the absence of specific tests or criteria the diagnosis of FES is dependent on the clinical acumen of the treating physician. It should be clinically suspected in patients with respiratory distress or a petechial rash and are at high risk for developing FES.
| Treatment | | |
Pharmacologic interventions
Therapeutic treatments developed specifically for FES have been largely unsuccessful. Early experiments attempted to use dextrose to decrease free fatty acid mobilization or ethanol to decrease lipolysis; however, neither have shown clinical benefits. [30],[31] Anticoagulation with heparin was found to be beneficial in animal models but is no longer commonly used in clinical practice due to the risk of bleeding and unproven benefits. [32],[33],[34]
Corticosteroidtherapy has been proposed as a potential therapy for FES by limiting free fatty acid levels, stabilizing membranes, and inhibiting complement mediated leukocyte aggregation. Meta-analysis of seven randomized trials using prophylactic corticosteroids in patients with long-bone fractures found that corticosteroids reduce the risk of FES by 77% (95% CI: 40-91%). [35] This same trial reported no difference in mortality, infection, or avascular necrosis in patients treated with corticosteroids compared to control patients. This meta-analysis, though, included only one recent trial. A 2004 randomized trial found no difference in incidence of FES between patients treated with methylprednisolone. [7]
While still controversial, some clinicians administer corticosteroids to patients with long-bone fractures as FES prophylaxis. Methylprednisolone is the most commonly used steroid and dosages range from 6 to 90 mg/kg.
Placement of inferior venal cava filters has been advocated as a method to reduce showering of emboli to the pulmonary vasculature. IVC filters as a prophylactic treatment to prevent FES have not been sufficiently studied.
Supportive treatment
Once a patient develops FES the only proven treatment is supportive care of the involved organ systems. Supplemental oxygen may be required to improve oxygenation. If ARDS develops the patient may require mechanical ventilation while recovering from lung injury. Patients may require intravenous fluid for resuscitation to avoid developing shock. In severe cases, in which a fat pulmonary embolism causes, right ventricular failure ionotropic support with dobutamine may be necessary. [36]
Patients with neurological manifestations require frequent neurological examinations and documentation of Glascow Coma Scale to assess for neurologic deterioration. Rapid deterioration may develop from increased cerebral edema. [20] Patients with FES and cerebral edema may benefit from placement of an intracranial pressure monitor in order to direct treatment of cerebral edema. [37]
Operative fixation
Early operative fixation of long-bone fractures is advocated to reduce the incidence of FES. In the long-bone, fractures were treated conservatively with prolonged immobilization, with the incidence of FES in these patients reported as 22%. [38] The movement of fracture ends prior to operative fixation have been shown to result in transient showering of fat embolism. [39] Cytokines remain persistently elevated in patients undergoing conservative treatment and then return to normal after operative fixation. [40]
The use of internal fixation devices for treatment of long bone fractures was accompanied by a reduction in the incidence of FES. [41] Several retrospective studies have also reported decreased incidence of FES with use of internal fixation devices. [11],[42],[43],[44],[45],[46],[47] Johnson et al. further demonstrated that patients undergoing fixation urgently had an incidence of ARDS of 7% compared to an incidence of ARDS of 39% in patients that had fixation delayed by more than 24 h. [43]
Increased intramedullary pressure during fixation increases the amount of fat emboli entering the circulation. [48] Care must be taken during operative fixation to limit intramedullary pressure.
While reaming may increase intramedullary pressure, reaming has not been shown to increase the incidence of FES. A randomized trial comparing pulmonary complications in patients undergoing fixation with reamed nailing and unreamed nailing found no difference between the two groups. [49] When assessed with transesophageal echocardiography, patients undergoing fixation with reamed and unreamed nails had visible pulmonary embolism. [50]
Surgical techniques to reduce embolization including drilling holes in the cortex to reduce intramedullary pressure, lavaging bone marrow prior to fixation to reduce marrow for embolization, venting of the femur, use of a bone-vacuum, and use of tourniquets to prevent embolization have been attempted. None of these have clearly been shown to reduce FES. [51],[52],[53],[54],[55]
Morbidity and mortality
With supportive care and early fixation FES has a favorable outcome. The most significant morbidity is associated with the development of ARDS. However, most patients can expect a complete recovery of pulmonary, neurologic, and retinal abnormalities. Mortality rates from FES in modern studies utilizing supportive measures and early operative fixation report the mortality from FES between 7% and 10%. [9],[10]
| Conclusion | | |
FES most commonly presents with respiratory distress in orthopedic trauma patients. No specific diagnostic tests or criteria exist, so the syndrome is most often a diagnosis of exclusion. Therapy is most often directed at treatment of ARDS and support of other organ systems affected by fat embolization. Early operative fixation long-bone fractures have reduced the incidence of FES.
| References | | |
| 1. | Scuderi CS. The present status of fat embolism. Bibliographic review. Int Surg Digest 1934;18:195-215. 
|
| 2. | Gauss H. The pathology of fat embolism. Arch Surg 1924;9:592-605.
|
| 3. | Wilson JV, Salisbury CV. Fat embolism in war surgery. Br J Surg 1943;31:384-92.
|
| 4. | Gurd AR. Fat embolism: An aid to diagnosis. J Bone Joint Surg Br 1970;52:732-7.
[PUBMED] |
| 5. | Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br 1974;56B:408-16.
[PUBMED] |
| 6. | llardyce DB, Meek RN, Woodruff B, Cassim MM, Ellis D. Increasing our knowledge of the pathogenesis of fat embolism: A pro- spective study of 43 patients with fractured femoral shafts. J Trauma 1974;14:955-62.
[PUBMED] |
| 7. | Wong MW, Tsui HF, Yung SH, Chan KM, Cheng JC. Continuous pulse oximeter monitoring for inapparent hypoxemia after long bone fractures. J Trauma 2004;56:356-62.
[PUBMED] |
| 8. | Pell AC, Christie J, Keating JF, Sutherland GR. The detection of fat embolism by transoesophageal echocardiography during reamed intramedullary nailing. A study of 24 patients with femoral and tibial fractures. J Bone Joint Surg Br 1993;75:921-5.
[PUBMED] |
| 9. | Bulger EM, Smith DG, Maier RV, Jurkovich GJ. Fat embolism syndrome. A 10-year review. Arch Surg 1997;132:435-9.
[PUBMED] |
| 10. | Fabian TC, Hoots AV, Stanford DS, Patterson CR, Mangiante EC. Fat embolism syndrome: Prospective evaluation in 92 fracture patients. Crit Care Med 1990;18:42-6.
[PUBMED] |
| 11. | Riska EB, Myllynen P. Fat embolism in patients with multiple injuries. J Trauma 1982;22:891-4.
[PUBMED] |
| 12. | Duis HJ, Nijsten MW, Klasen HJ, Binnendijk B. Fat embolism in patients with an isolated fracture of the femoral shaft. J Trauma 1988;28:383-90.
[PUBMED] |
| 13. | Nijsten MW, Hammer JP Dius HJ, Posma JL. Fat embolism and patent foreamen ovale. Lancet 1989;1:1271.
|
| 14. | Nixon JR, Brock-Utne JG. Free fatty acid and arterial oxygen changes following major injury. A correlation between hypoxemia and increased free fatty acid level. J Trauma 1978;18:23-6.
[PUBMED] |
| 15. | Parker FB, Wax SD, Kusajima K, Webb WR. Hemodynamic and pathological findings in experimental fat embolism. Arch Surg 1974;108:70-4.
|
| 16. | Bokhari SI, Alpert JS. Probable acute coronary syndrome secondary to fat embolism. Cardiol Rev 2003;11:156-9.
[PUBMED] |
| 17. | Burger LW, Dines DE, Linscheid RL. Fat embolism syndrome and the adult respiratory distress syndrome. Mayo Clinic Proc 1974;49:107-9.
|
| 18. | McCarthy B, Mammen E, Leblanc LP, Wilson RF. Subclinical fat embolism: A prospective study of 50 patients with extremity fractures. J Trauma 1973;13:9-16.
[PUBMED] |
| 19. | Butteriss DJ, Mahad D, Soh C, Walls T, Weir D, Birchall D. Reversible cytotoxic cerebral edema in cerebral fat embolism. AJNR Am J Neuroradiol 2006;27:620-3.
[PUBMED] |
| 20. | Meeke RI, Fitzpatrick GJ, Phelan DM. Cerebral edema and fat embolism syndrome. Intensive Care Med 1987;13:291-2.
[PUBMED] |
| 21. | Gossling HR, Pellegrin VD. Fat embolism syndrome. A review of the pathophysiology and physiologic basis of treatment. Clin Orthop Relat Res 1982;56:408-16.
|
| 22. | Adams CB. The retinal manifestations of fat embolism. Injury 1971;2:221-4.
[PUBMED] |
| 23. | Chuang EL, Miller FS 3 rd , Kalina RE. Retinal lesions following long bone fractures. Ophthalmology 1985;92:370-4.
|
| 24. | Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE, et al. Fat embolism prophylaxis with corticosteroid: A prospective study in high-risk patients. Ann Intern Med 1983;99:438-43.
[PUBMED] |
| 25. | Lindeque BG, Schoeman HS, Dommissen GF, Boeyens MC, Vlok AL. Fat embolism syndrome: A double blind therapeutic study. J Bone Joint Surg Br 1987;69:128-31.
|
| 26. | White T, Petrisor BA, Bhandari M. Prevention of fat embolism syndome. Injury 2006:37S:S59-67.
|
| 27. | Mimoz O, Edouard A, Beydon L, Quillard J, Verra F, Fleury J, et al. Contribution of bronchoalveolar lavage to the diagnosis of posttraumatic pulmonary fat embolism. Intensive Care Med 1995;21:973-80.
[PUBMED] |
| 28. | Chastre J, Fagon JY, Soler P, Fichelle A, Dombret MC, Huten D, et al. Bronchoalveolar lavage for rapid diagnosis of the fat embolism syndrome in trauma patients. Ann Intern Med 1990;113:583-8.
[PUBMED] |
| 29. | Vedrinne JM, Guillaume C, Gagnieu MC, Gratadour P, Fleuret C, Motin J. Bronchoalveolar lavage in trauma patients for diagnosis of fat embolism syndrome. Chest 1992;102:1323-7.
[PUBMED] |
| 30. | Stoltenberg JJ, Gustilo RB. The use of methylprednisolone and hypertonic glucose in the prophylaxis of fat embolism syndrome. Clin Orthop Relat 1979;211-21.
|
| 31. | Schier MR, Wilson RF, James RE, Riddle J, Mammen EF, Pedersen HE. Fat embolism prophylaxis: A study of four treatment modalities. J Trauma 1977;17:621-9.
|
| 32. | Saldeen T. Intravascular coagulation in the lungs in experimental fat embolism. Acta Chir Scand 1969;135:653-62.
[PUBMED] |
| 33. | Burhop KE, Selig WM, Beeler DA, Malik AB. Effect of heparin on increased pulmonary microvascular permeability after bone marrow aspiration in awake sheep. Am Rev Respir Dis 1987;136:134-41.
[PUBMED] |
| 34. | Laterre PF, Wittebole X, Dhainaut JF. Anticoagulant therapy in acute lung injury. Crit Care Med 2003;31:S329-36.
[PUBMED] |
| 35. | Bederman SS, Bhandari M, McKee MD, Schemitsch EH. Do corticosteroids reduce the risk of fat embolism in patient with long bone fractures? A meta-analysis. Can J Surg 2009;52:386-93.
[PUBMED] |
| 36. | Kerbaul F, Rondelet B, Motte S, Fesler P, Hubloue I, Ewalenko P, et al. Effects of norepinephrine and dobutamine on pressure load induced heart failure. Crit Care Med 2004;32:1035-40.
[PUBMED] |
| 37. | Sie MY, Toh KW, Rajeev K. Cerebral fat embolism: An indication for an ICO monitor? J Trauma 2003;55:1185-6.
[PUBMED] |
| 38. | Riska EB, von Bonsdorff H, Hakkinen S, Jaroma H, Kiviluoto O, Paavilainen T. Prevention of fat embolism by early internal fixation of fractures in patients with multiple injuries. Injury 1976;8:110-6.
[PUBMED] |
| 39. | Tachakra SS, Potts D, Idowu A. Early operative fracture management of patients with multiple injuries. Br J Surg 1990;77:1194.
|
| 40. | Schoffel U, Bonnaire F, van Specht BU, Kuner EH. Monitoring the response to injury. Injury 1991;22:377-82.
|
| 41. | Meek RN, Vivoda EE, Pirani S. Comparison of mortality of patients with multiple injuries according to type of fracture treatment-a retrospective age- and injurymatched series. Injury 1986;17:2-4.
[PUBMED] |
| 42. | Goris RJ, Gimbrere JS, van Niekerk JL, Schoots FJ, Booy LH. Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 1982;22:895-903.
|
| 43. | Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress in patients with multiple musculoskeletal injuries: Effect of early operative stabilization of fractures. J Trauma 1985;25:375-84.
[PUBMED] |
| 44. | Svenningsen S, Nesse O, Finsen V, Hole A, Benum P. Prevention of fat embolism syndrome in patients with femoral fractures-immediate or delayed operative fixation? Ann Chir Gynaecol 1987;76:163-6.
[PUBMED] |
| 45. | Talucci RC, Manning J, Lampard S, Bach A, Carrico CJ. Early intramedullary nailing of femoral shaft fractures: A cause of fat embolism syndrome. Am J Surg 1983;146:107-11.
[PUBMED] |
| 46. | Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures: A prospective randomized study. J Bone Joint Surg 1989;71:336-40.
[PUBMED] |
| 47. | Brundage SI, McGhan R, Jurkovich GJ, Mack CD, Maier RV. Timing of femur fracture fixation: Effect on outcome in patients with thoracic and head injuries. J Trauma 2002;52:299-307.
[PUBMED] |
| 48. | Christie J, Robinson CM, Pell AC, McBirnie J, Burnett R. Transcardiac echocardiography during invasive intramedullary procedures. J Bone Joint Surg Br 1995;77:450-5.
[PUBMED] |
| 49. | Anwar IA, Battistella FD, Neiman R, Olson SA, Chapman MW, Moehring HD. Femur fractures and lung complications: Aprospective randomized study of reaming. Clin Orthop Relat Res 2004;422:71-6.
[PUBMED] |
| 50. | Coles RE, Clements FM, Lardenoye JW, Wermeskerken GV, Hey LA, Nunley JA, et al. Transesophageal echocardiography in quantification of emboli during femoral nailing: Reamed versusunreamed techniques. J South Orthop Assoc 2000;9:98-104.
[PUBMED] |
| 51. | Martin R, Leighton RK, Petrie D, Ikejiani C, Smyth B. Effect of proximal and distal venting during intramedullary nailing. Clin Orthop Relat Res 1996;332:80-9.
[PUBMED] |
| 52. | Dalgorf D, Borkhoff CM, Stephen DJ, Finkelstein J, Kreder HJ. Venting during prophylactic nailing for femoral metastases: Current orthopedic practice. Can J Surg 2003;46:427-31.
[PUBMED] |
| 53. | Byrick RJ, Bell RS, Kay JC, Waddell JP, Mullen JB. High-volume, high-pressure pulsatile lavage during cemented arthroplasty. J Bone Joint Surg Am 1989;71:1331-6.
[PUBMED] |
| 54. | Hagley SR. The fulminant fat embolism syndrome. Anaesth Intensive Care 1983;11:162-6.
[PUBMED] |
| 55. | Pitto RP, Koessler M, Kuehle JW. Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during total hip arthroplasty. A prospective, randomized clinical trial. J Bone Joint Surg Am 1999;81:831-43.
[PUBMED] |
[Table 1], [Table 2], [Table 3]
| This article has been cited by | | 1 |
A Case of Fulminant Fat Embolism Syndrome With Very Early Onset After Femoral Neck and Sacral Fractures |
|
| Seigo Kimura, Ryokichi Yagi, Fumihisa Kishi, Daiji Ogawa, Keiichi Yamada, Hirokatsu Taniguchi, Masahiko Wanibuchi | | Cureus. 2023; | | [Pubmed] | [DOI] | | | 2 |
Fatal Fulminant Fat Embolism Syndrome in Adult Spine Deformity Surgery |
|
| Janez Mohar | | JBJS Case Connector. 2022; 12(2): 4 | | [Pubmed] | [DOI] | | | 3 |
Factors Associated with Postoperative Lipiduria and Hypoxemia in Patients Undergoing Surgery for Orthopedic Fractures |
|
| Chih-Hui Chen, Yun-Che Wu, Yu-Cheng Li, Feng-An Tsai, Jen-Ying Li, Jun-Sing Wang, Cheng-Hung Lee | | Frontiers in Surgery. 2022; 9 | | [Pubmed] | [DOI] | | | 4 |
Post-Trauma Combined Pulmonary Fat and Bone Embolism: Literature Review with Case Presentation |
|
| Sara Sablone, Gerardo Cazzato, Lorenzo Spagnolo, Caterina Berterame, Federica Mele, Francesco Introna, Aldo Di Fazio | | Forensic Sciences. 2022; 2(2): 371 | | [Pubmed] | [DOI] | | | 5 |
Fat Embolism Syndrome Without Bone Fracture: Is It Possible? |
|
| Mustafa Bajraktari, Majlinda Naco, Gentian Huti, Blerim Arapi, Rudin Domi | | Open Access Macedonian Journal of Medical Sciences. 2022; 10(C): 331 | | [Pubmed] | [DOI] | | | 6 |
Fat Embolism Syndrome With Cerebral Involvement: An Underrecognized Complication of Long Bone Fractures |
|
| Quang L Nguyen, Benadin Varajic, Samuel B Reynolds, Karim El-Kersh | | Cureus. 2022; | | [Pubmed] | [DOI] | | | 7 |
A Rare Case of Fat Embolism Syndrome Masquerading as COVID-19 Pneumonia |
|
| Zaheer Faizi, Daniel W Kim, Ammar Humayun, Amber Batool, Ashanthi Ratnasekera | | Cureus. 2022; | | [Pubmed] | [DOI] | | | 8 |
Cerebral Fat Embolism: A Rare East African Conundrum |
|
| Larry Mburu, Katie Du, Sylvia Mbugua, Jacqueline Mavuti, Sayed K Ali | | Cureus. 2022; | | [Pubmed] | [DOI] | | | 9 |
Cerebral Fat Embolism After a Fall |
|
| Patrick Gibbons, Maura Kennedy, Pierre Borczuk, Da'Marcus Baymon | | The Journal of Emergency Medicine. 2022; | | [Pubmed] | [DOI] | | | 10 |
Fat embolism syndrome with neurological involvement: A case report |
|
| Andrew R. Ostlie, Megan Gilbert, Carey Lewis, Daniel J. Ostlie, Angela Hargis-Villanueva | | Trauma Case Reports. 2022; : 100607 | | [Pubmed] | [DOI] | | | 11 |
Cerebral fat embolism syndrome in a patient with homozygous sickle cell disease in the setting of multisystem inflammatory syndrome in children |
|
| Kirstin Sepulveda, Tesneem Issa, Gueorgui Dubrocq | | Baylor University Medical Center Proceedings. 2022; : 1 | | [Pubmed] | [DOI] | | | 12 |
Concomitant post-traumatic ocular and cerebral fat embolism syndrome and thrombotic pulmonary embolism |
|
| Ying-Sheng Li, Yi-Hsueh Liu, Hung-Da Chou, Hsiang-Jui Tseng, Yin-Chih Fu, Wen-Chih Liu | | Medicine. 2022; 101(24): e29331 | | [Pubmed] | [DOI] | | | 13 |
Fat Embolism Syndrome Mimicking a COVID-19 Infection |
|
| Alexandru Leonard Alexa,Adela Hilda Onutu,Antonello Grippo | | Case Reports in Critical Care. 2021; 2021: 1 | | [Pubmed] | [DOI] | | | 14 |
An Early Case of Fat Embolism Syndrome Occurring Following Polytrauma |
|
| Janelle-Cheri A. Millen,Carrie Watson,John M. Cain,Joshua Hagan,Winston T. Richards,Dana Taylor,Darwin Ang,Jason M. Clark | | The American Surgeon. 2021; 87(1): 86 | | [Pubmed] | [DOI] | | | 15 |
Late-onset isolated cerebral fat embolism syndrome after a simple tibial plateau fracture: a rare case report |
|
| Ta-Li Hsu, Tien-Chi Li, Fei-Pi Lai, Ming Ouhyoung, Chih-Hung Chang, Cheng-Tzu Wang | | Journal of International Medical Research. 2021; 49(7): 0300060521 | | [Pubmed] | [DOI] | | | 16 |
Intraosseous fluid resuscitation causes systemic fat emboli in a porcine hemorrhagic shock model |
|
| Steinar Kristiansen, Benjamin Storm, Dalia Dahle, Terje Domaas Josefsen, Knut Dybwik, Bent Aksel Nilsen, Erik Waage-Nielsen | | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2021; 29(1) | | [Pubmed] | [DOI] | | | 17 |
Microbleeds show a characteristic distribution in cerebral fat embolism |
|
| Omar Giyab,Bendegúz Balogh,Péter Bogner,Orsi Gergely,Arnold Tóth | | Insights into Imaging. 2021; 12(1) | | [Pubmed] | [DOI] | | | 18 |
Early acute fat embolism syndrome caused by femoral fracture: A case report |
|
| Jia Yang,Zhong-Ning Cui,Jia-Nan Dong,Wen-Bo Lin,Jiang-Tao Jin,Xiao-Jie Tang,Xiao-Bo Guo,Shao-Bo Cui,Ming Sun,Chen-Chen Ji | | World Journal of Clinical Cases. 2021; 9(27): 8260 | | [Pubmed] | [DOI] | | | 19 |
When Fat Hits the Brain: Intraventricular and Subarachnoid Fat Migration Secondary to a Complex Sacropelvic Fracture—Diagnosis and Treatment |
|
| Manolis Polemikos,Felix Kiepe,Shadi Al-Afif,Paul Bronzlik,Joachim K. Krauss | | Journal of Neurological Surgery Part A: Central European Neurosurgery. 2021; | | [Pubmed] | [DOI] | | | 20 |
Zerebrales Fettemboliesyndrom nach Polytrauma |
|
| Philipp Georg Schnadthorst,Niklas Rieder,Martina Springer,Christoph Schulze | | Der Unfallchirurg. 2021; | | [Pubmed] | [DOI] | | | 21 |
Risk Stratification Algorithm for Orthopedic Trauma Patients at Risk for Fat Embolism Syndrome |
|
| Andrew Lowery,Vineet Naran,Robert Ames,Akul Patel,Frederick Ramsey,Bridget Slattery,Theresa Pazionis | | Indian Journal of Orthopaedics. 2021; | | [Pubmed] | [DOI] | | | 22 |
Transient cortical blindness in fat embolism syndrome---a diagnostic enigma |
|
| Kiyana Mirza,Prashant Upendra Acharya,Jose Austine | | Chinese Journal of Traumatology. 2021; | | [Pubmed] | [DOI] | | | 23 |
Fat embolism syndrome: Adding tiles to the crazy-paved mosaic of inflammation, lung injuries, and clinical findings |
|
| Francesco Bianco, Valentina Bucciarelli | | International Journal of Cardiology. 2021; | | [Pubmed] | [DOI] | | | 24 |
Ultrasonographic Findings in Fat Embolism Syndrome |
|
| Shun Yonezaki,Kazuya Nagasaki,Hiroyuki Kobayashi | | Clinical Practice and Cases in Emergency Medicine. 2021; 2(5): 263 | | [Pubmed] | [DOI] | | | 25 |
Predictive signs of fat embolism syndrome. Case-control study |
|
| A.A. Pevnev, A.Yu. Yakovlev, M.S. Belous, D.V. Ryabikov, V.I. Zagrekov | | Annals of critical care. 2021; (1): 143 | | [Pubmed] | [DOI] | | | 26 |
Cerebral Large Vessel Occlusion Caused by Fat Embolism—A Case Series and Review of the Literature |
|
| Suyi Ooi,Subahari Raviskanthan,Bruce C. V. Campbell,Elspeth J. Hutton,Peter J. Mitchell,Geoffrey C. Cloud | | Frontiers in Neurology. 2021; 12 | | [Pubmed] | [DOI] | | | 27 |
Fat Embolism Syndrome: The Ambiguity of Diagnosis in the Postarthroplasty Patient |
|
| Kenrick Rosser,Sophia Wilton,William J. Farrington | | JBJS Case Connector. 2020; 10(2): e19.00594 | | [Pubmed] | [DOI] | | | 28 |
A case of suspected cerebral fat embolism after mitral valve plasty |
|
| Hiromu Okano,Gen Owada,Yasuhiro Kimura,Taikan Nanao,Junichi Fujimoto,Hideo Nishizawa | | Journal of the Japanese Society of Intensive Care Medicine. 2020; 27(5): 421 | | [Pubmed] | [DOI] | | | 29 |
Relationship between bone disorders and stroke |
|
| Milija D. Mijajlovic,Vuk Aleksic,Natasa Stojanovski,Natan M. Bornstein | | Neurological Sciences. 2020; | | [Pubmed] | [DOI] | | | 30 |
Fat embolism syndrome in blunt trauma patients with extremity fractures |
|
| Miriam Alpert,Areg Grigorian,John Scolaro,James Learned,Matthew Dolich,Catherine M. Kuza,Michael Lekawa,Jeffry Nahmias | | Journal of Orthopaedics. 2020; 21: 475 | | [Pubmed] | [DOI] | | | 31 |
Yogun Bakimda Araç Disi Trafik Kazasi Sonrasi Ates: Yag Embolisi Sendromu |
|
| Sevil ALKAN ÇEVIKER,Emel YILDIZ,Mehmet Ali GEDIK,Alaaddin Oktar ÜZÜMCÜGIL,Süleyman Kaan ÖNER | | Mustafa Kemal Üniversitesi Tip Dergisi. 2020; | | [Pubmed] | [DOI] | | | 32 |
COVID-19 mimics on chest CT: a pictorial review and radiologic guide |
|
| Bruno Hochhegger,Matheus Zanon,Stephan Altmayer,Nicole S Mandelli,Guilherme Stüker,Tan-Lucien Mohammed,Nupur Verma,Gustavo Souza Portes Meirelles,Edson Marchiori | | The British Journal of Radiology. 2020; : 20200703 | | [Pubmed] | [DOI] | | | 33 |
A rare case of fat embolism syndrome secondary to abdominal liposuction and gluteal fat infiltration |
|
| Salvador Recinos,Sabrina Barillas,Alejandra Rodas,Javier Ardebol | | Journal of Surgical Case Reports. 2020; 2020(12) | | [Pubmed] | [DOI] | | | 34 |
Integrating Fat Embolism Syndrome Scoring Indices in Sickle Cell Disease: A Practice Management Review |
|
| Keneisha Bailey,Jagila Wesley,Adebayo Adeyinka,Louisdon Pierre | | Journal of Intensive Care Medicine. 2019; 34(10): 797 | | [Pubmed] | [DOI] | | | 35 |
Fat embolism in right internal jugular vein: incidental ultrasound finding during internal jugular vein cannulation |
|
| Osman Adi,Chan Pei Fong,Azlizawati Azil,Shaik Farid Abdul Wahab | | The Ultrasound Journal. 2019; 11(1) | | [Pubmed] | [DOI] | | | 36 |
Air embolism through open hub of external jugular vein intravenous cannula |
|
| Chitta R. Mohanty,Suma R. Ahmad,Mantu Jain,Bhavna Sriramka | | Turkish Journal of Emergency Medicine. 2019; 19(3): 117 | | [Pubmed] | [DOI] | | | 37 |
The Potential Role of Corticosteroid Prophylaxis for the Prevention of Microscopic Fat Embolism Syndrome in Gluteal Augmentations |
|
| Tyler Safran,Jad Abi-Rafeh,Becher Alhalabi,Peter G Davison | | Aesthetic Surgery Journal. 2019; | | [Pubmed] | [DOI] | | | 38 |
Liposuction fat emboli resulting in myocardial infarction: a case report and review of the literature |
|
| Luke J. Grome,Erica Bartlett,Shayan Izaddoost | | European Journal of Plastic Surgery. 2019; | | [Pubmed] | [DOI] | | | 39 |
Fat embolism syndrome: choice and effectiveness of laboratory diagnostic methods |
|
| Vladimir Karpov,Irina Kleina,Sergey Kazakov,Daniil Korabelnikov,Shamilć Gizatullin | | Russian Medical and Social Journal. 2019; 1(2): 71 | | [Pubmed] | [DOI] | | | 40 |
Un caso de síndrome de embolia grasa: tratamiento y rehabilitación neurológica y cognitiva |
|
| José Daniel Villegas,María Camila Zapata,María Camila Jaramillo,Estefanía Orozco,Juan Camilo Suárez | | Biomédica. 2019; 39(1): 22 | | [Pubmed] | [DOI] | | | 41 |
CLINICAL EFFICACY OF METABOLICALLY ACTIVE FLUID THERAPY IN PATIENTS WITH FAT EMBOLISM SYNDROME |
|
| Aleksey Y. Yakovlev, A.A. Pevnev, M.S. Belous, S.A. Tezyaeva, D.V. Ryabikov, S.I. Chistyakov, T.A. Galanina | | Annals of critical care. 2018; (2): 51 | | [Pubmed] | [DOI] | | | 42 |
A Systematic Review of the Causes and Management of Nonthrombotic Embolic Stroke of Tissue Origin |
|
| Sarah Mello,Ciaran Judge,Roisin Kelly,David Bradley,Joseph Harbison | | Stroke Research and Treatment. 2018; 2018: 1 | | [Pubmed] | [DOI] | | | 43 |
Experimental Justification of the Use of Colloidal Blood Substitutes for Fat Globulemia |
|
| A. Yu. Yakovlev,?. S. Belous,A. ?. Pevnev,D. V. Ryabikov | | General Reanimatology. 2018; 14(5): 50 | | [Pubmed] | [DOI] | | | 44 |
Cerebral Fat Embolism: Clinical Presentation, Diagnostic Steps and Long-Term Follow-Up |
|
| Juliane Dunkel,Christian Roth,Frank Erbguth,Wenke Dietrich,Monika Hügens-Penzel,Andreas Ferbert | | European Neurology. 2017; 78(3-4): 181 | | [Pubmed] | [DOI] | | | 45 |
Strategies for Reducing Fatal Complications in Liposuction |
|
| Lázaro Cárdenas-Camarena,Lozano-Peńa Andrés Gerardo,Héctor Durán,Jorge Enrique Bayter-Marin | | Plastic and Reconstructive Surgery - Global Open. 2017; 5(10): e1539 | | [Pubmed] | [DOI] | | | 46 |
Fat Emboli Syndrome in a Child with Duchenne Muscular Dystrophy After Minor Trauma |
|
| Loretta Stein,Richard Herold,Andrea Austin,William Beer | | The Journal of Emergency Medicine. 2016; | | [Pubmed] | [DOI] | | | 47 |
Fat Embolism Syndrome in Long Bone Fractures |
|
| Robin Hughes | | JBJS Journal of Orthopaedics for Physician Assistants. 2016; 4(2): 5 | | [Pubmed] | [DOI] | | | 48 |
Acute pulmonary edema following liposuction due to heart failure and atypical pneumonia |
|
| Uwe Wollina,Andreas Graf,Volkmar Hanisch | | Wiener Medizinische Wochenschrift. 2015; | | [Pubmed] | [DOI] | | | 49 |
Pancréatite aiguë necrotico-hémorragique secondaire ŕ une embolie graisseuse post-traumatique « ŕ propos d’un cas » |
|
| Olfa Turki,Mabrouk Bahloul,Kamilia Chtara,Hédi Chelly,Mounir Bouaziz | | La Presse Médicale. 2015; 44(12): 1283 | | [Pubmed] | [DOI] | | | 50 |
Deaths Caused by Gluteal Lipoinjection |
|
| Lázaro Cárdenas-Camarena,Jorge Enrique Bayter,Herley Aguirre-Serrano,Jesús Cuenca-Pardo | | Plastic and Reconstructive Surgery. 2015; 136(1): 58 | | [Pubmed] | [DOI] | | | 51 |
Posttravmatik Yag Embolisi ve Adli Tibbi Degerlendirmesi Olgu Sunumu |
|
| Orhan Meral,Nihal Erdogan,Hülya Güler,Ahsen Kaya,Aytaç Koçak | | The Bulletin of Legal Medicine. 2014; 19(3): 185 | | [Pubmed] | [DOI] | | | 52 |
Magnetic resonance imaging of traumatic brain injury: a pictorial review |
|
| Christopher Aquino,Sean Woolen,Scott D. Steenburg | | Emergency Radiology. 2014; | | [Pubmed] | [DOI] | | | 53 |
Fettpartikler i blodet |
|
| Vegard Dahl | | Tidsskrift for Den norske legeforening. 2014; 134(12/13): 1253 | | [Pubmed] | [DOI] | | | 54 |
Surgical Stabilization of Femur Fractures in Posttraumatic Hypoxemic Patients: When and Why? |
|
| Ramesh K Sen,G D Puri,Indu Mohini,Anil Pratap,Nirmal Raj | | Archives of Trauma Research. 2014; 3(2) | | [Pubmed] | [DOI] | | | 55 |
Definitive femur fracture management while on extracorporeal membrane oxygenation for trauma related respiratory failure |
|
| Ellen A. Carraro,Michael S. Firstenberg,Thomas J. Papadimos,Laura Phieffer,Eric Abel,Daniel S. Eiferman | | Mechanical Circulatory Support. 2013; 4(0) | | [Pubmed] | [DOI] | |
|
 |
|
|
|
