The fat embolism syndrome is considered to be a symptom complex of acute
respiratory distress, cerebral disturbance and petechiae after one or more long bone
fractures. The clinical picture of a full-blown fat embolism syndrome may develop
within 72 hr after trauma mostly and must be differentiated from cardiogenic pulmonary
edema, aspiration pneumonia, pulmonary thromboembolism and sepsis. The symptoms of
fat embolism syndrome is disappeared after several days of supportive care, for example
oxygen therapy, but seldom cases develop adult respiratory distress syndrome. We
reviewed 4 cases of fat embolism syndrome, their clinical characteristics and outcome,
from April 1987 to July 1989 at Severance Hospital.
The results are as follows:
1) Age of patient was from 31 to 89 year and the male to female ratio was 1:1.
2) Out of the 4 patients, 3 were car accidents and one was falling down.
3) Hypoxia was noted in all patients from 7 to 72 hr after injury. On breathing room
air, the mean arterial oxygen tension was 54 ㎜Hg (Range 44 to 671, and the mean
alveolar-arterial oxygen gradient was 54 ㎜Hg(range 40 to75).
4) Petechiae were appeared on the anterior chest wall of all patients, and also noted
on the anterior axillary fold, subconjuctiva and abdominal wall.
5) Cerebral disturbances were manifested in all patients, as confusion, agitation and
drowsy state.
6) Thrombocytopenia was noted in 3 cases (range 45,000 to 72,000/㎜3),
prolongation of the prothrombin time and partial thromboplastin time was noted in a
case. Increase of fibrin degradation products was noted in 2 cases and abnormal X-ray
pattern was noted in 2 cases as interstitial pulmoary edema and patchy pneumonic
infiltration.
7) Hypoxia was controlled after 3-9 days of nasal oxygen therapy alone. Cerebral
disturbance was disappeared 24 hours after the onset of symptoms and
thrombocytopenia was corrected 2-7 days after insult-with supportive care.
In conclusion fat embolism syndrome must be considered in all long bone fracture,
especially multiple lower leg fracture. Early immobilization, adequate fluid and blood
replacement and careful monitoring of blood gas tension, chest X-ray and physical
status is important to these patients for prevention and early detection of fat embolism
syndrome. If fat embolism syndrome is appeared, early oxygen therapy must be initiated
with other supportive management. Mechanical ventilation with PEEP and corticosteroid
therapy can be considered in severe cases.
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