Fat embolism causing MCA infarct

Case contributed by Dr Yune Kwong

Presentation

Day 3 post left hip hemiarthroplasty. Found to have left hemiparesis on morning ward round.

Patient Data

Age: 81
Gender: Female
Modality: X-ray

Initial xrays show an intra-capsular left femoral neck fracture. This was treated with a cemented hemiarthoplasty.

Modality: CT

See below. 

Case Discussion

This case illustrates the importance of reviewing fine slices on CT, if available. MCA bifurcation emboli are much easier to see on thin slices, whether of high or low density (as in this case).

Reaming of the intra-medullary canal and the use of cemented techniques (as occurred with our patient) are known to be risk factors for the development of fat embolism1. Fat embolism mainly occurs in the setting of long bone fractures, and can happen whether the fracture is treated operatively or non-operatively. Less common traumatic causes include massive soft tissue injury, severe burns, bone marrow biopsy and transplant, CPR, liposuction and median sternotomy. Non-traumatic causes are uncommon but have been reported, and include acute pancreatitis, fatty liver, steroid therapy, lymphography, fat emulsion infusion and haemoglobinopathies2.

The treatment of fat embolism syndrome is mainly supportive3. Thrombolytic therapy is not likely to be effective as it not composed of thrombus. In this case, the unknown time of onset and extensive involvement of the MCA territory (more than one-third) were further contra-indications.

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Case Information

rID: 22373
Case created: 28th Mar 2013
Last edited: 15th Dec 2015
Inclusion in quiz mode: Included

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