Fat Embolism Syndrome: Correlation of Clinical Criteria & Imaging Studies

Nissar Shaikh; Arshad Chanda; Adel Ganaw; Muhammad Zubair; M. A. Rahman; Syed Imran Ghuori; Umais Momin

Nissar Shaikh Department of Anesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation/ Weill Cornell Medical College, Doha, Qatar.
Arshad Chanda Department of Anesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation/ Weill Cornell Medical College, Doha, Qatar.
Adel Ganaw Department of Anesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation/ Weill Cornell Medical College, Doha, Qatar.
Muhammad Zubair Department of Anesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation/ Weill Cornell Medical College, Doha, Qatar.
M. A. Rahman Department of Anesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation/ Weill Cornell Medical College, Doha, Qatar.
Syed Imran Ghuori Department of Surgery, Orthopedic Section, Hamad Medical Corporation, Doha, Qatar.
Umais Momin Department of Radiology, Hamad Medical Corporation, Doha, Qatar.

Keywords: Fat embolism syndrome, hypoxia, Intramedullary nailing, imaging studies, neurological deterioration, petechial skin rash

Abstract

Background: Fat embolism syndrome (FES) is a multi-organ dysfunction caused by the fat emboli. The diagnostic of FES remains a challenge for clinicians. The clinical criteria although universally used for diagnosis of FES are not specific. Imaging studies are increasingly used in the patients with presumed FES. The aim of this chapter is to determine whether there is a correlation between the clinical parameters and the imaging findings in confirming the FES diagnosis.

Methods: All patients admitted with FES to the surgical intensive unit were enrolled in this study. Patient's demographic data, admission diagnosis, associated injuries, comorbid conditions, time to deteriorate, surgical duration, clinical manifestations, imaging findings and outcome were recorded. Data was entered into the SPSS program and required tests were applied for comparisons and p value <0.05 considered as significant.

Results: A total of 81 patients were enrolled in this study. Majority of patients (51/63%) were young male and without comorbidity (58/71.6%). About a half of the patients (49.4%) underwent intramedullary nailing for long bone fracture. Respiratory insufficiencies occurred in 98% patients and of them 11.1% had diffuse alveolar hemorrhage. Neurological deterioration was seen in 70% of the patients while the petechial skin rash was rare (2.5%). All patients had an abnormal chest x-ray but chest computerized tomography scan (CT) showed patchy alveolar opacities in 49 (60.5%) of them. Cerebral edema was a common finding in the CT brain while the brain magnetic resonance imaging (MRI) revealed a typical star field appearance in 28.4% of the patients. There was a significant correlation (P < 0.05) between the major and minor clinical criteria components and abnormal imaging findings.

Conclusions: The FES is common in young males with long bone fractures. Respiratory distress and neurological deterioration were common presentations. We suggest that the patients with suspected FES by clinical criteria, should have imaging studies to confirm the diagnosis.