Fat embolism syndrome

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

Overview

Epidemiology and Demographics

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

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

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Template:WikiDoc Sources

  1. Gerald L. Weinhouse. Fat Embolism Syndrome.