Updated: 2/13/2018

Fat Embolus Syndrome

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Snapshot
  • A 40-year-old woman presents to the emergency room after a liposuction procedure done two days ago. She is dyspneic and found to be hypoxemic. She has difficulty speaking but notes that the shortness of breath came on suddenly. She then becomes confused and disoriented to place and time. She develops weakness on the right arm that resolves after a few hours. There is no petechial rash seen.
Introduction
  • Fat embolism syndrome results from fat emboli often associated with long bone fractures
  • Occurs around 1-3 days after instigating event
  • Pathogenesis – not completely elucidated
    • globules of fat escape bone marrow-rich areas (long bones and pelvis) after trauma
    • transferred to arterial circulation
      • through patent foramen ovale (most close after birth, but few remain patent)
      • if emboli are small enough, can pass from venous to arterial circulation through lungs
  • Associated conditions/risk factors
    • trauma
    • long bone fracture
    • pelvic fractures 
    • liposuction
    • CPR
  • Classic triad
    • hypoxemia
    • neurological abnormalities
    • petechial rash (only 20-50% of cases)
Presentation
  • Symptoms
    • acute shortness of breath
      • occlusion of pulmonary vessels
    • petechiae in neck, chest, and axilla
      • occlusion of dermal capillaries by fat emboli
      • resolves in 5-7 days
    • altered mental status
      • occlusion of neurological vessels
      • confusion
      • seizures
      • focal deficits
      • typically fully reversible
Evaluation
  • Diagnosis by clinical history and exam
  • Chest radiography typically normal
  • MRI may show high intensity T2 signal, which indicates neurologic impairment
  • Biopsy if clinical diagnosis is unclear
Differential Diagnosis
  • ARDS
  • Acute lung injury
Treatment
  • Supportive care
  • Corticosteroids may be beneficial in life-threatening cases
    • limited evidence
Prognosis, Prevention, and Complications
  • Prognosis
    • most patients recover without any sequelae
 

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