Suspected fat embolism

Case contributed by Dr Charlie Chia-Tsong Hsu

Presentation

Post mechanical fall sustaining femoral shaft fracture. Patient underwent internal fixation procedure. Day 2 post operation the patient becomes hypoxic and tachycardic. CTPA was organized to exclude pulmonary embolism.

Patient Data

Age: 75 years
Gender: Female
X-ray

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

CT

Axial and coronal reformats (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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