대한흉부영상의학회 Korean Society of Thoracic Radiology

대한흉부영상의학회 Weekly Case 메뉴

Close

대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
Advanced Search..

Close

Weekly Chest CasesArchive of Old Cases

Case No : 1232 Date 2021-06-01

  • Courtesy of Jae Wook Lee, Kyung Eun Shin, Jai Soung Park / Soonchunhyang University Bucheon Hospital
  • Age/Sex 82 / F
  • Chief ComplaintAcute onset dyspnea after slip down.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Fat embolism syndrome
Radiologic Findings
Fig. 1. Chest anteroposterior radiograph showing diffuse and patchy increased opacities in both lung fields.
Figs. 2–5. Chest computed tomography scans showing multifocal patchy ground-glass opacities resulting in a geographic appearance without a predominant distribution. No filling defects are seen in the pulmonary artery.
Brief Review
The patient had a fracture in the right femoral neck due to a slip down.
Bronchoalveolar lavage analysis revealed oil red O-positive lipid globules in histiocytes (fat embolism clinically).
Fat embolism is an infrequent complication of long bone fractures, occurring in 1%–3% of patients with simple tibial or femoral fractures but in up to 20% of patients with more severe trauma. Its 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 initiate a toxic and inflammatory reaction in the endothelium. Vessel wall permeability is increased, and extravasations, interstitial hemorrhage, and alveolar wall damage with passage of blood and fat microglobules into the alveoli occur. 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 occurs within 12–24 h of the traumatic event. Chest imaging shows bilateral homogeneous and heterogeneous opacities and resolves within 1 week. The time interval between the traumatic event and radiographic abnormalities is usually 1–2 days, which allows differentiation from traumatic contusion.
The radiographic findings resemble those of acute respiratory distress syndrome from any cause and consist of widespread homogeneous and heterogeneous areas of increased opacity.
Please refer to
Case 837, Case 449, Case 297, Case 257,
KSTR imaging conference 2017 Spring  Case 10 ,
KSTR Imaging Conference 2014 Summer  Case 2 ,
KSTR Imaging Conference 2005 Summer  Case 2 ,
KSTR Imaging Conference 2004 Spring  Case 4,
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

No. of Applicants : 97

▶ Correct Answer : 77/97,  79.4%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - National cancer center hospital east , Japan SHIOTO ODA
  • - Other , Korea (South) HYEJIN YANG
  • - , Korea (South) HYEYOUNG CHOI
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
  • - , United Kingdom SAMSON KADE
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Japan CHIAKI SATO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Qatif Central Hospital , Saudi Arabia HANI MAKKY ALSALAM
  • - Kangwon National University Hospital , Korea (South) HAN SOL KANG
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - Other , Korea (South) HYEON IL CHOI
  • - , Korea (South) HYEWON CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
  • - Kyeongpook National University Hospital , Korea (South) HYEONJUN JANG
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan KANAE TAKAHASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) MYUNG WON SONG
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - , Korea (South) EUNJIN LEE
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - Korea University Ansan Hospital , Korea (South) MOIN HA
  • - Soonchunhyang University Hospital Bucheon , Korea (South) SEONGHWAN BYUN
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - Seoul Veterans Hospital , Korea (South) JANG SEONG WON
  • - , Japan HIROAKI ARAKAWA
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - Columbia asia refferal hospital,Bengaluru , India PRAVIN KUMAR M
  • - TB centre kasaragod. , India rikhy krishnan
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
  • - , Japan TOMOKI IMOKAWA
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - , Korea (South) WONJU HONG
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Kyemyung University Dongsan Hospital , Korea (South) DONG HYEON KIM
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 1/97,  1.0%
  • - Yeungnam University Medical Center , Korea (South) CHOI SOOYOUNG
▶ Semi-Correct Answer : 1/97,  1.0%
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • Top
  • Back

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Sang Young Oh, M.D., Ph.D Email : sangyoung.oh@gmail.com

This website is optimized for IE 10 and above.