Fat embolism syndrome: State-of-the-art review focused on pulmonary imaging findings. (April 2016)

• Record Type: Journal Article
• Authors: Newbigin, Katrina; Souza, Carolina A.; Torres, Carlos; Marchiori, Edson; Gupta, Ashish; Inacio, Joao; Armstrong, Mitchel; Peña, Elena
• Is Part Of: Respiratory medicine. Volume 113(2016)
• Page Start: 93
• Page End: 100
• Publication Date: 2016-04
• Subjects: Fat embolism -- Non thrombotic pulmonary embolism -- High resolution computed tomography -- Pulmonary imaging; FES fat embolism syndrome -- CT computed tomography -- ARDS adult respiratory distress syndrome -- HRCT high-resolution computed tomography -- MR magnetic resonance imaging -- DWI diffusion-weighted images; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2016.01.018
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Fat embolism syndrome (FES) is a rare but potentially fatal complication of trauma or orthopedic surgery, which presents predominantly with pulmonary symptoms. Modern intensive care has improved the mortality rates, however diagnosis remains difficult, relying predominantly on a combination of a classic triad of symptoms and non-specific, but characteristic radiological features. The aim of this review is to describe the main clinical and imaging aspects of FES, ranging from pathophysiology to treatment with emphasis on pulmonary involvement. Methods: We reviewed the currently published literature on the main characteristics of FES. Results: In a hypoxic patient with recent trauma or orthopedic surgery, the presence of diffuse, well-demarcated ground glass opacities or ill-defined centrilobular nodules on computed tomography (CT) of the chest are suggestive of FES. Conclusions: Combination of the classic clinical syndrome in the appropriate clinical setting, together with the characteristic imaging findings on chest CT, can help to achieve the correct diagnosis. Management remains predominantly supportive care, and the benefit of medical therapies such as corticosteroids and heparin remains unclear. Highlights: Clinical and imaging aspects are reviewed with emphasis on pulmonary involvement. Characteristic appearance of pulmonary FES on CT and cerebral FES on MRI. Management of FES remains supportive care.