Fat embolism syndrome: Difference between revisions

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   MeshNumber    = C14.907.355.350.454 |
   MeshNumber    = C14.907.355.350.454 |
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{{Fat embolism syndrome}}
{{Fat embolism syndrome}}  


'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


{{CMG}}
{{CMG}} {{AE}} {{FT}} {{ADG}}


== Overview ==
{{SK}} FES; fat emobolism


A '''fat embolism''' is a type of [[embolism]] that is often (but not always) caused by [[physical trauma]].  Fat emboli can occur whenever there is a *[[Pulmonary embolism]]
==[[Fat embolism syndrome overview|Overview]]==
*[[CT pulmonary angiogram]]. The original description of fat embolism was in 1873 by Von Bergmann: “Ein fall todlicher fettembolie.”  The fat embolism syndrome (FES) is characterized by the triad of [[hypoxemia]], mental status changes and [[petechiae]].  The syndrome is usually trauma related and seen with closed fractures of the long bones or pelvis.


== Epidemiology and Demographics ==
==[[Fat embolism syndrome historical perspective|Historical Perspective]]==


Patients with long bone fractures have a 1-20% chance of developing FES.  It has been reported in liposuction, fatty liver, burns, bone marrot transplant (BMT) and bone marrow (BM) harvesting, bone tumor lysis, and sickle cell disease.
==[[Fat embolism syndrome classification|Classification]]==


== Pathophysiology ==
==[[Fat embolism syndrome pathophysiology|Pathophysiology]]==


The pathogenesis of FES is not completely defined.  It is thought to be caused by blockage of vessels from systemic embolization of fat globules.  Echocardiographic reports have demonstrated echogenic material passing through the right atrium followed by increased pulmonary pressures and right heart pressures and subsequent paradoxical embolization of this material through a [[patent foramen ovale]] ([[PFO]]). 
==[[Fat embolism syndrome causes|Causes]]==


The fat induces a toxic, inflammatory reaction.  This inflammatory reaction is thought to be related to the production of free fatty acids.  Studies have shown that neutral fatty acids are not toxic , however, they are hydrolyzed over many hours to substances proven to cause [[ARDS]] in animal models.  Not surprisingly, [[C-reactive protein]] is usually elevated in these patients.  Levels of [[lipoprotein lipase]], and [[free fatty acids]] ([[FFA]]) are noted in animal models.
==[[Fat embolism syndrome differential diagnosis|Differentiating Fat Embolism Syndrome from other Diseases]]==


== Natural History ==
==[[Fat embolism syndrome epidemiology and demographics|Epidemiology and Demographics]]==
The syndrome typically occurs 12-24 hrs after the inciting event.  It can occur as early as 12 hrs and as late as 2 weeks.  Patients are often [[dyspneic]], [[tachypneic]] and [[hypoxic]].  50% of patients with FES require mechanical ventilation and progression to [[adult respiratory distress syndrome]] ([[ARDS]]) may develop.


The majority of patients develop neurologic abnormalities, usually after the development of respiratory distress.  The usualy demonstrate an acute confusional state that may progress to [[coma]].  In most cases, if the patient survives, the neurologic abnormalities are transient.
==[[Fat embolism syndrome risk factors|Risk Factors]]==


The [[petichial rash]] is the last finding to develop.  It occurs in only 30-50% of patients with FES.  It is most often found on the head, neck, anterior thorax, subconjunctiva and axilla.  It usually resolves in 5-7 days.
==[[Fat embolism syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


[[Scotoma]], [[fever]], [[lipiduria]], [[disseminated intravascular coagulation]] ([[DIC]]) and [[cardiogenic shock]] are seen.
==Diagnosis==
[[Fat embolism syndrome history and symptoms|History and Symptoms]] | [[Fat embolism syndrome physical examination|Physical Examination]] | [[Fat embolism syndrome laboratory findings|Laboratory Findings]] |  [[Fat embolism syndrome electrocardiogram|Electrocardiogram]] | [[Fat embolism syndrome chest x ray|Chest X Ray]] | [[Fat embolism syndrome CT|CT]] | [[Fat embolism syndrome MRI|MRI]] | [[Fat embolism syndrome echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Fat embolism syndrome other imaging findings|Other Imaging Findings]] | [[Fat embolism syndrome other diagnostic studies|Other Diagnostic Studies]]


== Diagnosis ==
==Treatment==
[[Fat embolism syndrome medical therapy|Medical Therapy]] | [[Fat embolism syndrome surgery|Surgery]] | [[Fat embolism syndrome primary prevention|Primary Prevention]] | [[Fat embolism syndrome secondary prevention|Secondary Prevention]] | [[Fat embolism syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Fat embolism syndrome future or investigational therapies|Future or Investigational Therapies]]


FES is a clinical diagnosis.  Chest X-rays are normal in the majority.  Some may have evidence of consolidation, edema or hemmorhage, usually in the periphery.  Pulmonary ventilation/perfusion scans (V/Q scans) demonstrate multiple subsegmental perfusion defects.
==Case Studies==
[[Fat embolism syndrome case study one|Case #1]]


The recovery of fat from pulmonary artery (PA) catheter wedged blood, sputum and urine is nonspecific.  One study found fat in 50% of sera from patients with long bone fractures who had no evidence of FES.  Bronchoscopy and bronchoalveolar lavage (BAL) seem to be more specific by demonstrating fat droplets in alveolar macrophages.
=== Chest X Ray ===
[[image:ARDS.jpg|thumb|left|Acute Respiratory Distress Syndrome (ARDS)]]
<br clear="left"/>
=== Echocardiography ===
Echocardiographic reports have demonstrated echogenic material passing through the right atrium followed by increased pulmonary pressures and right heart pressures and subsequent paradoxical embolization of this material through a patent foramen ovale (PFO). 
=== Other Diagnostic Studies ===
== Treatment ==
Mortality occurs in 5-15% of patients.  Early immobilization of fractures and operative rather than conservative management decrease the risk of FES.  Some studies have shown a benefit in steroid prophylaxis for patients at high risk for FES (closed pelvic fracture), while others have not.  There is no benefit to steroids after FES has developed.
== References ==
{{reflist|2}}
<ref>Gerald L. Weinhouse.  Fat Embolism Syndrome.</ref>
== Acknowledgements ==
Source of Initial Content: Morning report notes prepared by {{CMG}} and Dr. Duane Pinto
==External links==
* {{GPnotebook|973471750}}
* {{DukeOrtho|fat_embolism_syndrome}}
* [http://www.surgical-tutor.org.uk/default-home.htm?core/trauma/compartment_syndrome.htm~right Description of fat embolism]


{{Consequences of external causes}}
{{Consequences of external causes}}
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[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Orthopedics]]

Latest revision as of 06:06, 6 July 2020

Fat embolism syndrome
ICD-10 O88.8, T79.1
ICD-9 673.8
DiseasesDB 4766
MeSH C14.907.355.350.454

Fat embolism syndrome Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Fat embolism syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2] Aditya Ganti M.B.B.S. [3]

Synonyms and keywords: FES; fat emobolism

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Fat Embolism Syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


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