Snapshot A 60-year-old man presents to the emergency room after a motor vehicle accident. He is found to have a femur fracture on the right. He is admitted into the hospital to correct the fracture and observation. Two days after hospitalization, he develops sudden shortness of breath, followed by confusion, which is far from baseline according to his family. A petechial rash is noted on his chest. 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, pelvis) after trauma clogs up vessels Associated conditions/risk factors trauma long bone fracture pelvic fractures liposuction CPR Classic triad hypoxemia neurological abnormalities petechial rash Presentation Symptoms acute shortness of breath occlusion of pulmonary vessels petechiae in neck, chest, and axilla occlusion of dermal capillaries by fat emboli altered mental status occlusion of neurological vessels confusion seizures focal deficits typically fully reversible Evaluation Diagnosis by clinical history and exam 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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