Fat embolism syndrome

Revision as of 02:37, 9 August 2012 by WikiBot (talk | contribs) (Bot: Automated text replacement (-{{SIB}} + & -{{EJ}} + & -{{EH}} + & -{{Editor Join}} + & -{{Editor Help}} +))
Jump to navigation Jump to search

For patient information click here

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

WikiDoc Resources for Fat embolism syndrome

Articles

Most recent articles on Fat embolism syndrome

Most cited articles on Fat embolism syndrome

Review articles on Fat embolism syndrome

Articles on Fat embolism syndrome in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Fat embolism syndrome

Images of Fat embolism syndrome

Photos of Fat embolism syndrome

Podcasts & MP3s on Fat embolism syndrome

Videos on Fat embolism syndrome

Evidence Based Medicine

Cochrane Collaboration on Fat embolism syndrome

Bandolier on Fat embolism syndrome

TRIP on Fat embolism syndrome

Clinical Trials

Ongoing Trials on Fat embolism syndrome at Clinical Trials.gov

Trial results on Fat embolism syndrome

Clinical Trials on Fat embolism syndrome at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Fat embolism syndrome

NICE Guidance on Fat embolism syndrome

NHS PRODIGY Guidance

FDA on Fat embolism syndrome

CDC on Fat embolism syndrome

Books

Books on Fat embolism syndrome

News

Fat embolism syndrome in the news

Be alerted to news on Fat embolism syndrome

News trends on Fat embolism syndrome

Commentary

Blogs on Fat embolism syndrome

Definitions

Definitions of Fat embolism syndrome

Patient Resources / Community

Patient resources on Fat embolism syndrome

Discussion groups on Fat embolism syndrome

Patient Handouts on Fat embolism syndrome

Directions to Hospitals Treating Fat embolism syndrome

Risk calculators and risk factors for Fat embolism syndrome

Healthcare Provider Resources

Symptoms of Fat embolism syndrome

Causes & Risk Factors for Fat embolism syndrome

Diagnostic studies for Fat embolism syndrome

Treatment of Fat embolism syndrome

Continuing Medical Education (CME)

CME Programs on Fat embolism syndrome

International

Fat embolism syndrome en Espanol

Fat embolism syndrome en Francais

Business

Fat embolism syndrome in the Marketplace

Patents on Fat embolism syndrome

Experimental / Informatics

List of terms related to Fat embolism syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Template:Editor join

Overview

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

  • 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

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.

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).

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.

Natural History

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.

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.

Scotoma, fever, lipiduria, disseminated intravascular coagulation (DIC) and cardiogenic shock are seen.

Diagnosis

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.

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

Acute Respiratory Distress Syndrome (ARDS)


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

[1]

Acknowledgements

Source of Initial Content: Morning report notes prepared by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] and Dr. Duane Pinto

External links

Template:Consequences of external causes

Template:WikiDoc Sources

  1. Gerald L. Weinhouse. Fat Embolism Syndrome.