Background: Fat embolism syndrome (FES) is a multi-organ
dysfunction caused by the fat emboli. The diagnostic of FES remains a challenge
for clinicians. The clinical criteria although universally used for diagnosis
of FES are not specific. Imaging studies are increasingly used in the patients
with presumed FES. The aim of this chapter is to determine whether there is a
correlation between the clinical parameters and the imaging findings in
confirming the FES diagnosis. Methods:
All patients admitted with FES to the surgical intensive unit were enrolled in
this study. Patient's demographic data, admission diagnosis, associated
injuries, comorbid conditions, time to deteriorate, surgical duration, clinical
manifestations, imaging findings and outcome were recorded. Data was entered
into the SPSS program and required tests were applied for comparisons and p
value <0.05 considered as significant.
Results: A total of 81 patients were enrolled in this study. Majority of
patients (51/63%) were young male and without comorbidity (58/71.6%). About a
half of the patients (49.4%) underwent intramedullary nailing for long bone
fracture. Respiratory insufficiencies occurred in 98% patients and of them
11.1% had diffuse alveolar hemorrhage. Neurological deterioration was seen in
70% of the patients while the petechial skin rash was rare (2.5%). All patients
had an abnormal chest x-ray but chest computerized tomography scan (CT) showed
patchy alveolar opacities in 49 (60.5%) of them. Cerebral edema was a common
finding in the CT brain while the brain magnetic resonance imaging (MRI)
revealed a typical star field appearance in 28.4% of the patients. There was a
significant correlation (P < 0.05) between the major and minor clinical
criteria components and abnormal imaging findings. Conclusions: The FES is common in young males
with long bone fractures. Respiratory distress and neurological deterioration
were common presentations. We suggest that the patients with suspected FES by
clinical criteria, should have imaging studies to confirm the diagnosis.
Author(s) Details
Dr. Nissar Shaikh Author(s) Details
Department of Anesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation/ Weill Cornell Medical College, Doha, Qatar.
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