Fat embolism

Chest | Cardiology | Fat embolism (Disease)


Description

A fat embolism is a large fat droplet that enters the bloodstream. A fat embolism occurs most commonly following a fracture of the pelvis, femur, or tibia. Multiple fractures are more likely to lead to fat embolism than single fractures.

Symptoms of fat embolism usually begin 12 to 72 hours following the injury. Symptoms of fat embolism occur when the small fat droplets obstruct the small vessels in the lung or brain. The obstruction reduces the blood flow to parts of the lung or brain, causing those areas to malfunction.

Fat embolism may be of two kinds: (1) pulmonary fat embolism, widespread obstruction causing sudden death; (2) Systemic fat embolism may get lodged in capillaries of organs like brain, kidney, skin etc. causing minute hemorrhage and microinfarcts.

Causes and Risk factors

Pieces of fat from the bone marrow enter the blood vessels of the body that carry blood back to the heart (veins). These fat particles travel through the heart and lodge in the lungs causing the symptoms experienced. This disorder can occur during surgery or after a traumatic injury. A common scenario is fatty bone marrow entering the veins after a fracture to a large bone, such as the femur or pelvis, or after surgery on these bones. Fat emboli are usually widespread and cause symptoms 1-3 days after the injury or event. This disease is serious with 10%-20% of patients not surviving the event.

Embolized fat travels to the lung and occludes pulmonary capillaries. Fat emboli may cause cor pulmonale if adequate compensatory pulmonary vasodilation does not occur.

Circulating free fatty acids are directly toxic to pneumocytes and capillary endothelium in the lung, causing interstitial hemorrhage, edema and chemical pneumonitis.

Diagnosis and Treatment

The most effective prophylactic measure is to reduce long bone fractures as soon as possible after the injury. Treatment include possible anticoagulation, stabilization of fractures, inferior vena cava filter, oxygen, supportive care, and possible ICU hospitalization. ...