Case of the Month 2016-12, Page 5

Diagnosis: Fat Embolism Syndrome status post elective abdominal liposuction and reinjection of fat in the gluteal musculature for buttocks augmentation.

Discussion:
Fat embolism syndrome can be seen in various conditions such as:

  • Long bone fractures, pelvis factures or fractures of other marrow-containing bones
  • Orthopedic procedures
  • Soft tissue injuries (e.g. chest compressions with or without rib fractures)
  • Burns
  • Liposuction or lipoinjection
  • Bone marrow harvesting and transplant
  • Non-trauma related conditions such as pancreatitis, diabetes mellitus, osteomyelitic, panniculitis, bone tumor lysis, steroid therapy, sickle cell hemoglobinopathies, alcoholic fatty liver disease, lipid infusion, cyclosporin A solvent and intraoperative cell salvage.

Fat emboli may be the result of fat globules entering the bloodstream through tissue (usually bone marrow or adipose tissue) that has been disrupted by trauma or, alternatively, via production of the toxic intermediaries of plasma-derived fat (eg, chylomicrons or infused lipids).

Fat emboli can pass through pulmonary capillaries without shunting lesions and result in systemic embolization (brain, kidneys most commonly).

The classic triad of findings includes hypoxemia, neurologic abnormalities, and a petechial rash.
Imaging findings:

Chest CT

  • Three predominate patterns are observed:
    • round-glass change with geographic distribution
    • ground glass opacities with interlobular septal thickening
    • nodular opacities: no zone predominance or gravity dependence in the nodular pattern
    • filling defects in pulmonary arteries are rarely described in non-fulminant syndromes

Brain MRI

  • Acute ischemia with appropriate clinical history
    • Long bone or pelvic fractures, cardiac surgery, joint replacement surgery, liposuction or lipoinjection
  • Often mimics thromboembolic stroke
  • Commonly affects both gray and white matter (WM)
  • May affect deep and periventricular WM
  • May affect deep gray nuclei
  • May involve typical vascular territory
  • May mimic "watershed" infarct
  • NECT: Typically negative acutely
    • "Hypodense MCA" sign related to fat within MCA
  • T2WI: Multiple small, scattered hyperintense foci
  • DWI: Acute diffusion restriction

CT Abdomen and pelvis

  • End-organ injury can be seen as areas of infarctions

Sources:

“Fat Emboli Cerebral Infarction” StatDX.com (https://app.statdx.com/document/fat-emboli-cerebral-infarction/81d43d33-7c9c-406c-a895-e8e4e835bd92)

“Fat Emboli Syndrome” Radiopaedia.org (https://radiopaedia.org/articles/fat-embolism-syndrome)

“Fat Emboli Syndrome” UptoDate.com (https://www.uptodate.com/contents/fat-embolism-syndrome)

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