Some definitions

Fat Emboli: Fat particles or droplets

that travel through the circulation
Fat Embolism: A process by which
fat emboli passes into the
bloodstream and lodges within a
blood vessel.
Fat Embolism Syndrome (FES):
serious manifestation of fat
embolism occasionally causes
multi system dysfunction, the
lungs are always involved and next
is brain

Causes of FES
Blunt

Trauma
Long bone

(Femur,
tibia,
pelvic)
factures

Causes of FES
Non Trauma: agglutination of chylomicrons and
VLDL by high levels of plasma CRP.
disease-related

Diabetes, acute pancreatitis, burns, SLE, sickle cell

crisis

drug-related

parenteral lipid infusion

procedure-related

Orthopedic surgery, liposuction

Pathophysiology of FES
Exact mechanism unknown, but two main
hypothesis
1.Mechanical Hypothesis
2.Biochemical Hypothesis

Mechanical
Hypothesis
Obstruction of vessels and capillaries
Increase in intermedullary pressure forces fat and marrow into

bloodstream
Bone marrow contents enter the venous system and lodge in
the lungs as emboli
Smaller fat droplets may travel through the pulmonary
capillaries into the systemic circulation: Embolization to
cerebral vessels or renal vessels also leads to central nervous
system and renal dysfunction

Biochemical Hypothesis
Toxicity of free fatty acids
circulating free fatty acids directly affect the
pneumocytes, producing abnormalities in gas
exchange
Coexisting shock, hypovolemia and sepsis
impair liver function and augment toxic effects
of free fatty acids

Clinical Manifestations
Asymptomatic for the first 12-48 hours

Pulmonary Dysfunction
Respiratory Failure and ARDS (tachypnea, dyspnea, crackles,

cyanosis)
Hypoxemia
systemic arterial hypotension, a decrease in cardiac output,
and arrhythmias

Neurological (nonspecific)
acute confusion, headache, stupor, coma, rigidity or

convulsions

Dermatological Signs
A reddish brown petechial rash within 24-36 hours
distributed to the upper body, chest, neck, upper arm,

axilla, shoulder, oral mucous membranes and

conjunctivae

Clinical Manifestation

Diagnosis
Clinical examination preferred over diagnostic

Laboratory Studies
Arterial Blood Gases (ABGs)
Urine and sputum examination
Haemotological Tests
Biochemical tests

Imagining
Chest x-ray
shows multiple flocculent shadows (snow storm
appearance). picture may be complicated by infection
or pulmonary edema.
CT Scan brain
may be normal or may reveal diffuse white-matter
petechial haemorrhages
Helical CT Scan chest
may be normal as the fat droplets are lodged in
capillary beds. Can detect lung contusion, acute lung
injury, or ARDS may be evident.

Chest X-ray
ER admit
AP & expiratory film so we cannot
comment on cardiac shadow.
However, there is no evidence of
lung contusion, pneumo, haemo or
pneumohaemothorax.

SICU admit (12

hours later)
upper lobe diversion
and bilateral
pulmonary infiltrates

Altaf Hussain: A Fatal Fat Embolism. The Internet Journal of Anesthesiology, 2004. Vol

MRI showing foci of

ischemia suggestive of fat
embolism syndrome
post operative
day 2 showing
multiple
hyperintense areas
consistent with
multiple emboli

post operative day

14 and shows evolving
cortical infarctions

Source:http://www.ispub.com/journal/the_internet_journal_of_anesthesiology/volume_19_number_2/article/acute_fatal_fat_embolism_syndrome_in_bilateral_total_knee_arthroplasty_a_review_of_the_fa

Treatment
Prophylaxis
Immobilization and early internal fixation of fracture
High doses of corticosteroids

Medical
Self limiting disease. Support treatment for cardiovascular

and respiratory issues

Maintenance of intravascular volume
Albumin is recommended
Adequate analgesia
Heparin

Risk Factors

Prognosis
Most death contributed to pulmonary

dysfunction
Hard to determine exact mortality rate
Estimated less than 10%

House M.D Clip

Pulmonary Dysfunction
Respiratory Failure and ARDS (tachypnea,

dyspnea, crackles, cyanosis)

Hypoxemia
systemic arterial hypotension, a decrease in
cardiac output, and arrhythmias

Sources
Altaf Hussain: A Fatal Fat Embolism. The Internet Journal of Anesthesiology,
2004. Volume 8 Number 2.
Fabian T. Unraveling
1993;329:96163

the

fat

embolism

syndrome.

Engl

Med

U. Galway, J. E. Tetzlaff & R. Helfand : Acute Fatal Fat Embolism Syndrome In

Bilateral Total Knee Arthroplasty A Review Of The Fat Embolism
Syndrome. The Internet Journal of Anesthesiology. 2009 Volume 19
Number 2
Latif, A., Bashir, A., Aurangzeb. "Fat Embolism and Fat Embolism Syndrome;
Management Trends." Professional Med J 15.4 (2008): 407-413.