Suspected fat embolism

Case contributed by Dr Charlie Chia-Tsong Hsu

Presentation

75 year old female presented post mechanical fall sustaining femoral shaft fracture. Patient underwent internal fixation procedure. Day 2 post operation the patient becomes hypoxia and tachycardic. CTPA was organised to exclude pulmonary embolism.

Patient Data

Age: 75
Gender: Female
X-ray

1. Chest radiograph performed on admission to ED.
2. Chest radiograph performe day two post right femur internal fixation. Bilateral patchy/fluffy airspace opacities are present with mid to lower zone predominance. 

CT

Axial and coronal reformat (lung window) shows patchy ground-glass opacities with sharp margination between regions of involved and noninvolved lung resulting in a geographic appearance. No obvious apical-basal gradient, however, the right middle lobe and the lingula segments of the left upper lobe are relatively spared. No interlobular septal thickening. No pulmonary embolism detected (not shown). 

Fat embolism remains a clinical diagnosis. Case study by Malagari et at.describes possible HRCT features of mild pulmonary fat embolism.1 The predominate pattern is defined regions of ground glass opacities. Other pattern include centrilobular opacities and septal thickening.1 Although these imaging patterns are non-specific when taken into clinical context can raise the possibility of  fat embolism. 

Case Discussion

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Case information

rID: 19157
Case created: 11th Aug 2012
Last edited: 16th Jul 2017
System: Chest
Inclusion in quiz mode: Included

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