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Weekly Chest CasesArchive of Old Cases

Case No : 837 Date 2013-11-11

  • Courtesy of Kyung Won Doo, Eun-Young Kang / Korea University Guro Hospital
  • Age/Sex 18 / M
  • Chief ComplaintMental change and seizure. Hx:Motor cycle accident
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Fat embolism syndrome
Radiologic Findings
Chest CT shows diffuse ground-glass opacity resulting in a geographic appearance, without predominant distribution.
He had fracture in the shaft of left femur.
Diffusion weighted MRI of brain showed multiple restricted diffusion spots in gray white matter junction, deep white matter, both basal ganglia and thalamus, consistent with embolic infarction.
Brief Review
Fat embolism is an infrequent complication of long bone fracture, occurring in 1 - 3% of patients with simple tibial or femoral fractures but in up to 20% of individuals with more severe trauma. Less common causes include hemoglobinopathy, major burns, pancreatitis, overwhelming infection, tumors, blood transfusion, and liposuction.
The first mechanism is the production of free fatty acids, which initiates a toxic and inflammatory reaction in the endothelium. Vessel wall permeability is increased, and extravasations, interstitial hemorrhage, alveolar wall damage with passage of blood and fat microglobules into the alveoli are occurred. The second mechanism is the mechanical obstruction of the pulmonary vasculature by fat globules and aggregates of red blood cells and platelets.
A combination of pulmonary, cerebral, and cutaneous symptoms typically occur within 12-24 hours of the traumatic event. The time lapse between the traumatic event and radiographic abnormalities is usually 1-2 days, which allows differentiation from traumatic contusion. These show bilateral homogeneous and heterogeneous opacities and resolve within 1 week.
The radiographic findings resemble those in acute respiratory distress syndrome from any cause and consist of widespread homogeneous and heterogeneous areas of increased opacity.
Please refer to
Case 449, Case 297, Case 257,
References
1. Han D, Lee KS, Franquet T, et al. Thrombotic and nonthrombotic pulmonary arterial embolism: spectrum of imaging findings. Radiographics. 2003;23:1521-1539.
2. Georgopoulos D, Bouros D. Fat embolism syndrome: clinical examination is still the preferable diagnostic method. Chest. 2003;123:982-983.
Keywords
Lung, Embolic, Thromboembolic,

No. of Applicants : 88

▶ Correct Answer : 41/88,  46.6%
  • - Scans world , India Philson Mukkada
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - University of British Columbia , Canada Amr Ajlan
  • - humiic , Korea (South) Ju Won Lee
  • - , Korea (South) park ji hoon
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - ICD,MCH CALICUT , India rikhy krishnan
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Hopital Bichat , France, Metropolitan Pauline Pradere
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Korea University Ansan hosipital , Korea (South) Doran Hong
  • - Kyoto University , Japan Akihiko Sakata
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - otsu municipal hospital , Japan kenjirou iwaya
  • - , Korea (South) Kim sungmo
  • - Chonnam university hospital , Korea (South) Jang mi Baek
  • - kanto Rosai Hp , Japan Takana Yamakawa
  • - McGill university , Canada Badriya Al-Qassabi
  • - SNUH , Korea (South) Eui Jin Hwang
  • - CH de la C�te Basque , France Paul ARDILOUZE
  • - H�pital du Sacr , Canada Andrea Ojanguren
  • - CHU Saint Pierre , Belgium Abd Alla Fares
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center, Department of Radiology , Korea (South) Hongseok Ko
  • - Niigata University , Japan Atsushi Uehara
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - chungbuk national university hospital , Korea (South) jeehye kim
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - 異⑸ , Korea (South) sooncheul baek
  • - 異⑸ , China ZHANG YING
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - sahyadri speciality hospital , India kothareddy dileepreddy
  • - CHU Poitiers , France CHAN paul
  • - CAC Rennes , France nicolas gautier
  • - Medicheck health care , Korea (South) Chae Lim
  • - University of Tsukuba Hospital , Japan Sodai Hoshiai
  • - UWO , Canada S Lee
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - GHOL, Hopital de Nyon , Switzerland Benoit Rizk
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
▶ Correct Answer as Differential Diagnosis : 10/88,  11.4%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Christian medical college vellore , India Abhishek Khurana
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - prince salman bin abdulaziz university , Saudi Arabia NABIL GHALEB
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - 媛• , Korea (South) Hyun suk Cho
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - NASA SCANS , India RAKESH BHATIA
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
▶ Semi-Correct Answer : 1/88,  1.1%
  • - IRSA La Rochelle , France Denis Chabassiere
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