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Park, Kim, Lee, Kim, Kim, Yoon, Park, Shin, and Park: A Case of Fat Embolism Syndrome of Fat Globules Found in BAL Fluid after Recovery from Acute Respiratory Failure
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 61(6): 562-566.

Published online: 30 December 2006

DOI: https://doi.org/10.4046/trd.2006.61.6.562

A Case of Fat Embolism Syndrome of Fat Globules Found in BAL Fluid after Recovery from Acute Respiratory Failure

Song Ree Park, M.D., Hyun Soo Kim, M.D., Jae Hyung Lee, M.D., Sang Heon Kim, M.D., Tae Hyung Kim, M.D., Ho Joo Yoon, M.D., Sung Soo Park, M.D., Dong Ho Shin, M.D.1, Chan Kum Park, M.D.2

1Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

2Department of Pathology, Hanyang University College of Medicine, Seoul, Korea.

Address for correspondence: Dong Ho Shin, M.D. Division of Pulmonology Department of Internal Medicine Hanyang University College of Medicine, 17 Haeng Dang Dong, Sung Dong Ku, Seoul, 133-792, Korea. Phone: 02-2290-8348, Fax: 02-2298-9183, shindh@hanyang.ac.kr

Received 18 September 2006       Accepted 9 October 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Fat embolism syndrome is a rare clinical diagnosis of dyspnea with acute respiratory failure and neurological signs caused by a traumatic long bone fracture.
We report a case of fat embolism in a 22 year-old man after a traffic accident. Dyspnea and stuporous mental changes developed on the 1st day after the external fixation operation of a left metaphyseal femur fracture. On the following day, he was transferred from a hospital to this one because of acute respiratory failure. After recovery, macrophages with fat droplets were found in the bronchoalveolar lavage fluid 1.
It is important to diagnose a fat embolism as the correct cause of acute respiratory failure through the BAL in the acute state of fat embolism syndrome It is believed that clinically apparent or sometimes hidden fat embolism syndrome can be diagnosed from the BAL during the recovery state.

Keywords: Fat embolism syndrome, Bronchoalveolar lavage, Fat globules, Acute respiratory failure

Figures and Tables

Figure 1
(A) Chest AP shows no active lesion on trauma day. (B) On 4th day after trauma, diffuse bilateral infiltrations with ground glass opacities and consolidation were developed.
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Figure 2
Chest CT shows bilateral diffuse consolidations with ground glass opacities predominantly on dependant portions.
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Figure 3
On 3rd day after trauma, brain MRI shows multiple foci of high signal intensity in the bilateral cerebral hemispheres, deep and subcortical white matters, and corpus callosi.
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Figure 4
On the 13th hospital day, analysis of BAL fluid revealed fat-containing (lipid-laden) macrophages (oil red O stain, ×1000)
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Table 1
Gurd's diagnostic criteria of fat embolism
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References

1. Roger N, Xaubet A, Agusti C, Zabala E, Ballester E, Torres A, et al. Role of bronchoalveolar lavage in the diagnosis of fat embolism syndrome. Eur Respir J. 1995. 8:1275–1280.
2. Gossling HR, Donohue TA. The fat embolism syndrome. JAMA. 1979. 241:2740–2742.
3. Moylan JA, Birnbaum M, Katz A, Everson MA. Fat emboli syndrome. J Trauma. 1976. 16:341–347.
4. Johnson MJ, Lucas GL. Fat embolism syndrome. Orthopedics. 1996. 19:41–48.
5. ten Duis HJ. The fat embolism syndrome. Injury. 1997. 28:77–85.
6. Gurd AR. Fat embolism: an aid to diagnosis. J Bone Joint Surg Br. 1970. 52:732–737.
7. Lindeque BG, Schoeman HS, Dommisse GF, Boeyens MC, Vlok AL. Fat embolism and the fat embolism syndrome: a double-blind therapeutic study. J Bone Joint Surg Br. 1987. 69:128–131.
8. Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE, et al. Fat embolism prophylaxis with corticosteroids: a prospective study in high-risk patients. Ann Intern Med. 1983. 99:438–443.
9. Levy D. The fat embolism syndrome: a review. Clin Orthop Relat Res. 1990. 261:281–286.
10. Feldman F, Ellis K, Green WM. The fat embolism syndrome. Radiology. 1975. 114:535–542.
11. Nolte WJ, Olofsson T, Schersten T, Lewis DH. Evaluation of the Gurd test for fat embolism. J Bone Joint Surg Br. 1974. 56B:417–420.
12. Chastre J, Fagon JY, Soler P, Fichelle A, Dombret MC, Huten D, et al. Bronchoalveolar lavage for rapid diagnosis of the fat embolism syndrome in trauma patients. Ann Intern Med. 1990. 113:583–588.
13. Vedrinne JM, Guillaume C, Gagnieu MC, Gratadour P, Fleuret C, Motin J. Bronchoalveolar lavage in trauma patients for diagnosis of fat embolism syndrome. Chest. 1992. 102:1323–1327.
14. Wang JY, Kuo PH, Jan IS, Lee LN, Yang PC. Serial analysis of fat-containing macrophages in bronchoalveolar lavage fluid in a patient with fat embolism syndrome. J Formos Med Assoc. 2001. 100:557–560.
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