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Fat embolism syndrome is a life-threatening condition that can develop after orthopedic injury and surgery. This syndrome developed in a 19-year-old man after a traumatic femoral fracture that was surgically repaired with intramedullary nailing. The complications experienced by the patient highlight the importance of prevention and early detection of fat embolism syndrome. Although minimization of the syndrome focuses primarily on prehospital care and early stabilization of a patient's condition, prevention of the potential consequences requires early detection by bedside nurses who care for trauma and orthopedic patients. Detailed nursing assessment and rapid recognition and reporting of the signs and symptoms associated with fat embolism syndrome are key to improving the outcomes of these patients.

Fat emboli syndrome is a well-recognized complication of displaced long bone fractures, often times requiring internal fixation. Treatment is generally supportive and is most successful with early diagnosis. This article describes a case of fat emboli syndrome resulting from a nondisplaced tibia fracture treated with long leg casting. This case demonstrates that fat emboli should be considered as a potential complication of any long bone fracture and should be part of the differential diagnosis for any patient unconscious or in respiratory distress that has sustained a recent long bone fracture.

Ocular fat embolism syndrome in the complete absence of any cardiac defects is a rare phenomenon which is not commonly encountered in ophthalmic practice. We present a case of a 16-year-old girl with fat embolism syndrome and involvement of the retina after a tibial fracture without any cardiac defect.

Fat embolization (FE), the introduction of bone marrow elements into circulation, is a known complication of bone fractures. Although FE has been described in other animal models, this study represents the first reported cases of FE and bone marrow embolism in nonhuman primates. Histopathologic findings from cynomolgus macaques (Macaca fascicularis) indicated that in all 5 cases, fat and bone marrow embolization occurred subsequent to multiple bone marrow biopsies. In the most severe case, extensive embolization was associated pulmonary damage consistent with acute respiratory distress syndrome. Fat embolism syndrome (FES) is an infrequent clinical outcome of FE and is triggered by systemic biochemical and mechanical responses to fat in circulation. Although clinical criteria diagnostic of FES were not investigated at the time of death, this severe case may represent the fulminant form of FES, which occurs within 12 h after trauma. Bone marrow biopsy as an etiology of FES has been reported only once in humans. In addition, the association of embolization with bone marrow biopsies suggests that nonhuman primates may be a useful animal model of FE. FE and FES represent important research confounders and FES should be considered as a differential diagnosis for clinical complications subsequent to skeletal trauma.

Objective: To measure the amount of fat presented to the right heart during reaming and nail placement using two different reamer systems., Design: Prospective, randomized clinical trial., Setting: University-based Level I Trauma Center., Patients: 20 patients with femur fractures., Intervention: Patients with femur fractures were treated with intramedullary nailing using either reamer-irrigator-aspirator or a conventional reamer., Main Outcome Measure: four-chamber trans-esophageal echocardiogram was used to quantify the amount of fat presented to the right atrium., Results: There were 2 female and 18 male patients enrolled, 10 in each group. There was no significant difference (p = 0.10) between reaming systems on the opening reamer, which was expected since both trial limbs used the same opening reamer. However, during the first pass of the reamer, the RIA showed a nearly-significant decrease in the volume of fat in the right atrium (p = 0.06). During passage of the nail, there was a significant difference with Group B having less fat embolus than Group A (p = 0.01). The power of this study is 0.81. The mean ISS was not significantly different between the two groups, nor was the sex, age or race. There was one death from cardiac complications in a patient who showed no fat during any phase of the procedure. This patient had significant mitral and aortic regurgitation pre-operatively. There was one patient with clinical fat embolism syndrome and one patient with a nonunion., Conclusions: There is a statistically significant difference in the amount of fat presented to the lungs using a RIA versus conventional reamer., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Fat embolization following major trauma is reported to be a quite common event, while the clinical fat embolism syndrome (FES) seems to be a much rarer event. Fat embolism occurs in 2 up to 23% of patients with isolated femoral shaft fractures. This complication appears to be related not only to the fracture, but also to the timing of stabilization. Sometimes it may be impossible to perform histochemical reactions on frozen sections to detect fat emboli thus confirming diagnosis or suspicion of FES. The finding of fibrinogen and platelets around the apparently empty spaces in the blood vessels has been proposed as an evidence for vital reaction due to either a vital cellular reaction or a flotation mechanism, thus supporting an intravital fat embolism. We report a fatal case due to fat embolism syndrome in a young man hospitalized for a right femoral neck fracture, treated with orthopaedic surgery and subjected to an intra-surgery transesophageal echocardiography that revealed embolization of numerous highly echogenic bodies. Four hours after the onset of clinical symptoms the man died from respiratory failure. The autopsy confirmed the clinical diagnosis of fat embolism syndrome. The histological examination revealed a large amount of fat globules in cerebral and pulmonary arteries and in glomerular capillaries, as well as fibrin and platelet deposition confirmed by the positive results by Sudan III staining for lipids and immunohistochemistry with anti-CD61 and anti-fibrinogen antibodies. The quantitative classification of fat embolism was grade 3 of Sevitt's classification or grade 4 of Fineschi's quantification, according to the current quantitative microscopic methods used for grading fat embolism in pulmonary tissue., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

We report a case of a 78-year-old female with a proximal femur fracture caused by an accidental fall who died suddenly 1h after orthopaedic prosthesis insertion. Post-mortem computed tomography (CT) scan and histological examination of samples obtained with post-mortem percutaneous needle biopsies of both lungs were performed. Analysis of the medical history and the clinical scenario immediately before death, imaging data, and biopsy histology established the cause of death without proceeding to traditional autopsy. It was determined to be acute right ventricular failure caused by massive pulmonary fat embolism. Although further research in post-mortem imaging and post-mortem tissue sampling by needle biopsies is necessary, we conclude that the use of CT techniques and percutaneous biopsy, as additional tools, can offer a viable alternative to traditional autopsy in selected cases and may increase the number of minimally invasive forensic examinations performed in the future., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: Acute low back pain is a very common symptom and reason for many medical consultations. In some unusual circumstances it could be linked to a rare aetiology., Case Presentation: We report a 70-year-old man with an 8-month history of left posterior thigh and leg pain who had sudden confusion after a fall from standing. It was due to cerebral fat embolism suspected by computed tomography scan, later confirmed by brain magnetic resonance imaging (MRI). A spinal MRI scan was then performed and revealed a sacral fracture which drained into an unknown perineurial cyst (Tarlov cyst). Under medical observation the patient fully recovered within three weeks., Conclusions: Sacral perineurial cysts are rare, however they remain a potential cause of lumbosacral radiculopathy.

A 16-year-old woman was admitted to our hospital because of the motorbike accident On admission, her consciousness was alert, and she had lower lip laceration and left femur open wound. Brain CT showed no abnormality, but chest CT revealed slight left lungs sprain and her left femur was fractured in the radiograph. Debridement and the art of the steel wire pulling of the left femur fracture part were enforced under general anesthesia about two hours coming to a hospital later. Her awaking from anesthetizing after the operation was delayed, and the consciousness level gradually decreased. Head MRI diffusion weighted image (DWI) after about 36 hours coming to a hospital showed diffuse high signal region centering on the cerebral white matter. We diagnosed her as having cerebral fat embolism based on clinical course and MRI findings. DWI abnormal signals disappeared in three weeks and the symptoms had improved gradually. It is thought that head MRI-DWI is useful to diagnose and evaluate the pathophysiology of cerebral fat embolism.

Diffusion-weighted MRI, a type of MR technique that can distinguish between cerebral fat embolism and diffuse axonal injury, is presented in this report. Emergency physicians should consider using diffusion-weighted imaging in unconscious trauma patients when their brain CT scans are unremarkable.

Fat embolism (FE) is a consequence of skeletal trauma that occurs in more than 90% of cases of severe trauma. However, most of these emboli are clinically insignificant. We report the case of a 59-yr-old man with massive progressive fibrosis who died from widespread FE after a single-lung transplantation (SLT). The lung donor was a 22-yr-old woman who died from traumatic cerebral injury. She had sustained a closed fracture of the tibia, fibula and pelvis. The PaO(2)/FiO(2) before procurement was 452 mmHg. A left SLT using cardiopulmonary bypass was performed. In the immediate postoperative period, profound pulmonary edema in the transplanted lung developed, with overinflation of the native lung and systemic hypotension. Severe Primary Graft Dysfunction (PGD) was suspected and nitric oxide (NO) and independent lung ventilation (ILV) initiated. Over the next 24 h the patient's condition deteriorated and extracorporeal membrane oxygenation (ECMO) was initiated. The patient died 45 h after transplantation as cardiovascular and respiratory function continued to decline and massive thoracic bleeding secondary to coagulopathy appeared. Post-mortem examination revealed both massive FE in the non-transplanted donor lung and in the allograft lung. Only two previous cases of donor-acquired FE and PGD after lung transplantation (LT) have been reported. Occult pulmonary FE in a traumatized donor should be considered a cause of PGD.

We present the case of a 28-year-old man with an unusual aetiology of lipid-dense material in the subarachnoid space. CT of the head at presentation was normal. MRI of the spine revealed a defect in the dura at L5/S1, with avulsed left L5 and S1 nerve roots. Haematoma and marrow fat were observed in close relation to the dural tear adjacent to the sacral fracture. Head CT and MRI subsequently demonstrated new lipid-dense material and haemorrhage in the subarachnoid space after sacral instrumentation, presumably owing to transthecal displacement of fatty marrow.

Objective: To analyze the prevalence and frequency spectrum of the most relevant diseases found in the autopsies of patients who underwent a lung transplant and died in the first month after transplantation. To evaluate the consistency of the pre-and post-mortem diagnoses, comparing them with the Goldman et al. scale modified by Battle et al., Material and Methods: Retrospective and longitudinal analysis, comparison of the medical records and records of autopsies of patients who received a lung transplant in our center (University Hospital Marques de Valdecilla) from 1997 to 2007, who died in the early postoperative period (first month post-transplant). The discordance between clinical and pathological diagnosis was classified according to the classification of Goldman et al. and Battle et al. The Student t test for quantitative variables and chi-square for qualitative variables were used for the comparison of the groups., Results: The five class I errors are limited to respiratory diseases: 2 undiagnosed acute rejection, 1 bilateral pulmonary thromboembolism, 1 fat embolism and 1 hemorrhagic infarction of the lung graft. We found a significant difference (p=0.05) between days of survival of patients with group Class I errors (6+/-4.52 days) and patients from the group with no discrepancy (15.42+/-8.99)., Conclusion: The short time between transplant and death of the patient reduces the possibility of reaching a correct diagnosis. Because of this information, diagnostic possibilities must be maximized in life-threatening diseases during this period. Therefore, the rate of autopsy studies in this period should be 100%.

A 71-year-old man sustains multiple fractures in an accident; after a lucid interval he deteriorates neurologically and becomes comatose. Intracranial hemorrhage, status epilepticus, adverse drug reactions, toxic-metabolic, ischemic or infectious causes are subsequently ruled out. Development of petechiae and thrombopenia raises the possibility of fat embolism syndrome, which is confirmed in a MRI of the head 72 hours after the accident. We discuss current aetiologic concepts as well as diagnosis and clinical course of the cerebral fat embolism syndrome.

Embolism of fat and bone marrow tissue is quite often due to bone fractures but it is seldom with signs of systemic involvement as a fat embolism syndrome. The main forming factor is late stabilization of fractures and hypovolemia too. Clinical image of fat embolism syndrome results from lung and systemic microembolism which leads to activation of inflammatory and thrombogenic cascades. We present a case report of a 24-year-old male after bike accident in low speed suffering from isolated thighbone fracture--osteosynthesis was applied in 6 hours after injury. The very first day the organ failure and coma with negative CT occurred, then ARDS, petechiae into the skin of chest and conjunctiva, also embolic closure of a. centralis retinae. Treatment interventions included anticoagulation, steroids, artificial ventilation for 17 days. After 3 weeks from injury he was still unconscious (with GCS 10) so that we tried a hyperbaric oxygen therapy. The patient regained consciousness after 3 months after injury. One year later he is able to walk alone, he has no visual failure, but he is still quadruspastic although able to manipulate with a mobile phone. We discuss diagnostic criteria and treatment. We also point out need of volumetherapy in prevention of fat embolism syndrome--this was underrated here because of primary missed out diagnose of co-existing tibia fracture at the same time (this was stabilised 18 hours after injury).

Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. The pathologic consequences of fat embolism are well recognized. Fat embolism is most often associated with trauma and orthopedic injuries. Fat embolism syndrome (FES) is a serious manifestation of fat embolism that involves a cascade of clinical signs such as petechial rash, deteriorating mental status, and progressive respiratory insufficiency, usually occurring within 24 hours of injury. This article reviews the definition, epidemiology, etiology, pathophysiology, clinical presentation, diagnosis, management, and prognosis of FES.

Objective: To describe a case of a young man with delayed coma after mild head injury, suggestive of cerebral fat embolism (CFE). To underline the value of MR imaging in the differential diagnosis of secondary deterioration in mild head injury., Case Report: A 21-year-old man admitted with mild head injury after a fall with facial fractures and long bone fractures. He was admitted to the intensive care unit and was mechanically ventilated. Weaning was not possible because of desaturations and pulmonary congestion. Low platelet count and anaemia developed. On several time points during his admission cerebral imaging data were obtained. Non-contrast CT on admission was normal while follow-up MRI showed extensive white matter abnormalities. These imaging abnormalities combined with the clinical presentation suggests cerebral fat embolism (CFE) as the most likely cause of secondary deterioration in our patient., Conclusions: In head injured patients with long bone fractures one should consider cerebral fat embolism. When the classical clinical syndrome is not present, MR imaging is warranted for diagnosis and to exclude other causes of secondary deterioration.

I report on two cases of cerebral infarction caused by fat embolism during the orthopedic surgeries. The first patient was a 77-year-old woman with a femur neck fracture, who developed coma after orthopedic operation. The other was a 70-year-old woman with open fractures in the femur and the fibula, who developed hemiplegia after operation. By echogram, no embolus was demonstrated in the heart, in the carotid arteries or in deep veins, also paradoxical cerebral infarction was denied in the both cases. Diffusion-weighted MR image and FLAIR MR image showing multiple hyperintense signals in the hemispheres were very useful as a diagnosing modality in acute stage. The patients gradually recovered with the intensive treatment.

Fat embolism syndrome (FES) is a common and life-threatening clinical syndrome, which is a difficult problem frequently encountered in medical science, especially in forensic medicine and orthopaedics. FES would be easily mistaken or missed by forensic examiner due to the lack of the specific symptoms and signs. This article reviews the etiology, pathogenesis, pathology, the mechanism of death, as well as the advances of the forensic medicine diagnosis of FES with current literatures update.

Objective: To analysis and discuss the early diagnosis and treatment of fat embolism syndrome caused by the injuries in Wenchuan earthquake happened in May 12th, 2008., Methods: To carry out dynamic blood and oxygen analysis and blood routine examination for the 13 fat embolism syndrome patients wounded in the earthquake, and combine with clinical features and early diagnosis, inject hydrocortisone injection, dextran 40 glucose injection and Dan Shen Root injection. Meanwhile, pay attention to supporting the respiratory function and correcting hypoxemia., Results: Of 13 patients, 12 cases were rescued successfully, and the successful rate was 92.3%, while one cases died from respirometric failure with fat embolism syndrome and secondary hemorrhagic pneumonia., Conclusions: The key to treating fat embolism syndrome is the early diagnosis and timely and accurate treatment. Supporting the respiratory function, correcting hypoxemia and early high-dose combination of hormone treatment are the effective treatment methods.

Background: In experimental studies, embolization of the cerebral hemisphere with triolein emulsion has revealed reversible magnetic resonance imaging (MRI) findings in the subacute stage., Purpose: To investigate the changes in the major metabolites, by proton magnetic resonance spectroscopy (MRS), in a cerebral fat embolism induced by a triolein emulsion., Material and Methods: The internal carotid arteries of 19 cats were injected with a triolein emulsion, and multivoxel MRS was performed 30 min, 1 day, and 7 days later. In the control group, six cats were injected with normal saline. The MR spectra were evaluated for N-acetyl aspartate (NAA), creatine (Cr), and choline (Cho), along with the presence of lipid and lactate. Semiquantitative analyses of NAA/Cr, Cho/Cr, NAA/Cho, and lipid/Cr ratios compared the median values of the ipsilateral metabolite ratios with those of the contralateral side and in the control group for each point in time., Results: The NAA/Cr, Cho/Cr, and NAA/Cho ratios in the ipsilateral cerebral hemisphere of the embolized group after 30 min, 1 day, and 7days were not significantly different from the contralateral hemisphere of the embolized and control groups (P>0.05). The lipid/Cr ratio in the ipsilateral cerebral hemisphere of the embolized group was significantly higher when compared with the control group (P=0.012 at 30 min, P=0.001 on day 1, and P=0.018 on day 7)., Conclusion: Cerebral fat embolism induced by a triolein emulsion resulted in no significant change in the major metabolites of the brain in the acute stage, except for an elevated lipid/Cr ratio, which suggests the absence of any significant hypoxic-ischemic changes in the lesions embolized using a fat emulsion.

Pericardial suction blood (PSB) is known to be contaminated with fat droplets, which may cause embolic brain damage during cardiopulmonary bypass (CPB). This study aimed to investigate the possibility to detect fat emboli by a Doppler technique. An in vitro flow model was designed, with a main pump, a filter, a reservoir, and an injector. A Hatteland Doppler probe was attached to the circulation loop to monitor particle counts and their size distribution. Suspended soya oil or heat-extracted human wound fat was analyzed in the model. The concentrations of these fat emboli were calibrated to simulate clinical conditions with either a continuous return of PSB to the systemic circulation or when PSB was collected for rapid infusion at CPB weaning. For validation purpose, air and solid emboli were also analyzed. Digital image analysis was performed to characterize the nature of the tested emboli. With soya suspension, there was an apparent dose response between Doppler counts and the nominal fat concentration. This pattern was seen for computed Doppler output (p = .037) but not for Doppler raw counts (p = .434). No correlation was seen when human fat suspensions were tested. Conversely, the image analysis showed an obvious relationship between microscopy particle count and the nominal fat concentration (p < .001). However, the scatter plot between image analysis counting and Doppler recordings showed a random distribution (p = .873). It was evident that the Doppler heavily underestimated the true number of injected fat emboli. When the image analysis data were subdivided into diameter intervals, it was discovered that the few large-size droplets accounted for a majority of total fat volume compared with the numerous small-size particles (< 10 microm). Our findings strongly suggest that the echogenecity of fat droplets is insufficient for detection by means of the tested Doppler method.

Background: Venous air embolism (VAE) or fat embolism (FE) may occur in similar clinical settings such as after multiple injuries or total hip replacement. We designed this study to observe the differences between VAE and FE in routine intraoperative monitoring methods, transesophageal echocardiography (TEE), and fatal volume in pigs., Methods: Sixteen domestic pigs were randomly assigned to either a fat group (n = 8) or an air group (n = 8). Each animal was injected with a series of volumes of air or fat. TEE and routine intraoperative monitoring were used during the experiment. The echogenic pattern of air or fat emboli were recorded and was graded (grade 0, no emboli; grade 1, a few fine emboli; grade 2, embolic masses less than 5 mm in diameter and the right atrium opacified with echogenic materials; grade 3, fine emboli mixed with large embolic masses greater than 5 mm in diameter or serpentine emboli). Precordial auscultation was performed before and after each injection of air or fat. The fatal volumes of air and fat were recorded., Results: No echogenic pattern grade 3 on TEE in the fat group was observed even fatal volume of fat was injected, whereas echogenic pattern grade 3 was found in all pigs in the air group when > or = 0.5 mg/kg of air was injected (0/8 vs. 8/8, p < 0.01). Paradoxical embolism and cutaneous petechiae was more common in the fat group than in the air group (8/8 vs. 1/8, 6/8 vs. 0/8, p < 0.05). "Bubble-like" sounds, "drum-like" murmurs, and "mill-wheel" murmurs were only heard in the air group but not in the fat group (8/8 vs. 0/8, p < 0.01). Fatal volume of air was much higher than that of fat (4 mL/kg +/- 0.76 mL/kg vs. 0.24 mL/kg +/- 0.05 mL/kg, p < 0.01)., Conclusions: Large extensive echogenic masses on TEE, "bubble-like" sounds, "drum-like" murmurs, and "mill-wheel" murmurs were more likely associated with VAE. All of fat emboli were fine on TEE. Paradoxical embolism and cutaneous petechiae were more common in FE. Fatal volume of fat is lower than that of air.

Fat embolism syndrome (FES) is an uncommon but serious complication of traumatic injury and is frequently diagnostically challenging. In this paper, the authors present four patients who sustained lower extremity long bone injury and who had a normal Glasgow Coma Scale before orthopedic surgical intervention. However, postoperatively, significant neurological deterioration developed in these patients. While cranial computed tomography (CT) obtained immediately after surgery for acutely altered mental status was negative in two of the four patients, brain magnetic resonance imaging (MRI) demonstrated white and gray matter abnormalities accounting for the impaired neurological status in all cases. MRI findings in conjunction with clinical presentation established the diagnosis in all patients. MRI is indicated in any patient with orthopedic injuries who manifests an unexplained acute alteration in mental status, despite a normal head CT.

Introduction: Fat embolism syndrome (FES) is a potentially serious, but poorly diagnosed, complication in polytraumatized patients., Case Report: A 19 year-old male was admitted in our hospital with tibia and fibula fracture and no evidence of cranial traumatism or neurological symptoms. He underwent surgical reduction and internal fixation of the fractures. A few hours later, his consciousness suddenly deteriorated and he developed myoclonic jerks in his upper limbs. A computed tomography scan of the brain and lumbar puncture showed no abnormalities. The electroencephalograph demonstrated frontotemporal spike-wave activity with tendency to generalization. Diagnosed of epileptic status, he was treated with intravenous valproic acid. The myoclonia disappeared and the patient regained consciousness. A magnetic resonance imaging (MRI) scan of the head performed 68 h later showed multiple high intensity signals throughout the white matter which were seen on the diffusion weighted images as bright spots. Echocardiography did not demonstrate patent oval foramen. The patient was discharged from hospital without sequels and with the diagnosis of FES. The control MRI at 5 weeks showed the persistence of the lesions without restriction in diffusion sequence., Conclusions: FES is a frequent complication that is underdiagnosed and potentially serious. It should be considered in polytraumatized patients. The manipulation performed in the orthopedic reduction seems to have played an important role in the patient's condition. MRI allows for the diagnosis and characterization of acute lesions in the central nervous system, ruling out other etiologies.

Fat embolism syndrome is a rare complication occurring in 0.5 to 2% of patients following a long bone fracture. It is believed to be caused by the toxic effects of free fatty acids. Diagnosis is clinical, based on respiratory, cerebral and dermal manifestations. Treatment is only supportive, directed mainly at maintaining respiratory functions.

Fat embolism syndrome is associated with respiratory failure, hypoxia, petechial rash, pyrexia and altered mental state. Signs and symptoms usually begin within 12-72 h after trauma. The pathophysiology, differential diagnosis and therapeutic options of fat embolism syndrome are described and the case of a 29-year-old motorcyclist with fractures of the lower extremities, coma and respiratory failure 24-36 h after an accident is reported. Based on the clinical signs and course, fat embolism syndrome was suspected which was substantiated by ophthalmic fundoscopy and magnetic resonance imaging of the head.

The postmortem diagnosis of fat embolism syndrome (FES), traditionally based on the histological demonstration of fat globules, needs a quantitative analysis of both the size and localization of the fat emboli, which is essential for a reliable grading of the pulmonary fat embolism. The clinical data and the autopsy records of 2738 autopsies were retrospectively evaluated, and 21 cases in which FES was pointed out as cause of death were selected and compared with 21 fatal cases referred to as major trauma in which the cause of death was not attributed to fat embolism, and with 47 fatal cases as control group, respectively. The following parameters were investigated: the total area of the embolized tissue; the total number of emboli; the mean area of the emboli; the mean percentage of the embolized tissue area as compared with the total tissue area of each sample; the total percentage of the embolized tissue area as compared with the total tissue area of all slides. The most reliable parameters seem to be the ratio between embolized tissue areas as compared with the total tissue area of each sample. These parameters showed a good correlation with the clinical data.

We report a patient who was diagnosed as fat embolism syndrome after replantation surgery of left amputated foot. This diagnosis was based on the presence of a long bone fracture with an amputation of a major extremity, supported by the signs of pulmonary and cerebral dysfunction and confirmed by the demonstration of arterial hypoxemia in the absence of other disorders.

Authors present the frequency, pathological disorders and consequences of fat microembolia of the lung. Peculiarities of fat embolia in patients with blunt traumas of the foot and shin were shown in the article. Rare cases (2) of SPE manifestation in patients with fat embolia of the lung, experience of pathogenetic therapy of complications and recommendations regarding diagnostics of complications in patients with this disease are given in the article.

Primary lung graft dysfunction is one of the major causes of perioperative morbidity and mortality in lung transplantation. Primary lung graft dysfunction is a clinical syndrome occurring in the immediate postoperative period after lung transplantation and is characterized by severe hypoxemia, pulmonary edema, and pulmonary infiltrates on chest x-ray film, requiring that the patient remain intubated and thus favoring pulmonary infection, sepsis, and subsequent multiple organ failure in the transplanted patient. It has recently been shown that unexpected pulmonary embolism is relatively common in the donor and is associated with primary lung graft dysfunction. However, we believe that only one case of primary lung graft dysfunction due to pulmonary fat embolism has been documented histologically in patients undergoing lung transplantation. The objective of this study is to report our experience with a case of primary lung graft dysfunction due to fat embolism in the donor lung detected in the morphologic study.

An active duty male presented to the emergency room with dyspnea for 2 days after undergoing liposuction surgery. Upon presentation, the patient was afebrile, tachycardic, tachypneic, and hypoxemic. The initial chest radiograph demonstrated bilateral patchy opacities and the PaO2/FiO2 ratio was <200. The patient was admitted to the medical intensive care unit for supportive care. He was treated empirically for pneumonia. Blood and sputum cultures were negative. A computed tomography angiogram of the chest was negative for pulmonary embolism but did reveal a bilateral, perihilar air space process. The patient's oxygen requirement improved and the abnormal chest radiographic findings resolved over the next 48 hours. Given his clinical presentation, negative workup, and rapid recovery, the patient was given a presumptive diagnosis of pulmonary fat embolism. Fat embolism occurs when adipocytes and small blood vessels are damaged during the liposuction procedure. Patients may present with low-grade fever, tachycardia, tachypnea, hypoxemia, and hypocapnia. The differential diagnosis includes venous thromboembolism, aspiration pneumonitis, and pneumonia. The mainstay of treatment for pulmonary fat embolism is supportive care. The risk of mortality is 5 to 15%.

Purpose: To describe a case of fat embolism syndrome (FES) following elective tendon contracture release in a patient with myotonic dystrophy, to highlight the importance of considering this entity in the differential diagnosis of acute postoperative neurocognitive dysfunction., Clinical Features: A 34-yr-old man with myotonic dystrophy underwent uneventful tendon contracture release under regional anesthesia. In the immediate postoperative period, neurological and respiratory complications developed, requiring intensive care support. The patient showed the classical clinical triad of hypoxemia, neurological impairment and a petechial rash associated with the FES. A diagnosis of FES was made and, despite therapy including fluid and inotropic support, the patient succumbed to the condition. There was no demonstrated intracardiac shunt, suggesting a physiological intrapulmonary shunt was responsible for the development of systemic manifestations of FES., Conclusions: Postoperative neurological dysfunction is a difficult condition with numerous possible causes. All possible etiologies, including FES, need to be considered in the differential diagnosis and postoperative management of patients developing acute postoperative neurological impairment and hypoxemia.

Admission rates of orthopedic patients to intensive care units are increasing. Thus, an intensivist's familiarity with specific problems associated with major joint replacement surgery is of utmost importance in order to meet the needs of this particular patient population. In this article, the authors review the most commonly encountered complications after major hip and knee arthroplasty. Perioperative risk factors for morbidity and mortality and the epidemiology, diagnosis, and treatment of cardiopulmonary complications in this patient population are discussed. Procedure-specific complications such as fat embolism and acrylic bone cement-related issues are reviewed.