Fat embolism syndrome pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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.