Fat embolism syndrome

Background

  • Caused by fat globules in pulmonary microcirculation [1]
  • Fat is prothrombotic and pro-inflammatory
  • Commonly associated with orthopedic fractures, especially long bone fractures of lower extremities (eg. femur)
  • Occurance in Men > women, highest rates: ages 10-40 y/o
  • Typically occurs 12-72 hrs after initial insult

Clinical Features

Differential Diagnosis

Evaluation

Clinical diagnosis, no gold standard

Gurd's Criteria

  • Most frequently cited diagnostic criteria
  • Need 1 major, 4 minor

Major

  • Petechial rash
  • Resp symptoms w XR changes
  • CNS signs unrelated to another condition

Minor

  • Tachycardia
  • Pyrexia
  • retinal changes (fat or petechiae)
  • renal abnormalities (oliguria, anuria or lipiduria)
  • thrombocytopenia
  • acute anemia
  • elevated ESR
  • fat globules in sputum
  • Chest Xray/CT scan chest
    • Bilateral patchy infiltrates
  • MRI brain: star-field pattern of diffuse, punctate, hyperintense lesions on DWI
  • Bronchoalveolar lavage
    • 30% of alveolar cells staining for fat strongly asso w diagnosis

Management

Acute Care

  • Supportive care
  • Heparin and steroids have not shown improvement
  • Supplemental O2, mechanical ventilation if needed
  • Frequent neurochecks, consider ICP monitoring
  • Vasopressors as needed
  • Refractory hypotension/shock: consider ECMO

Prevention

  • Decreased incidence with orthopedic repair within 24h
  • Consider prophylactic corticosteroids in patients with long bone fractures
    • Decreased hypoxemia, no difference in mortality

Disposition

  • ICU

See Also

External Links

References

  1. Kosova, E. et al. Fat Embolism Syndrome. Circulation. 2015; 131:317-320