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Fat embolism syndrome: an autopsy-proven case involving a patient on dialysis and systemic scleroderma.

Nishimura N, Banno S, Kimura Y, Maeda S, Kobayashi M, Kawai K, Suga N, Suzuki K, Miura N, Yokoi T, Imai H - Clin Med Insights Case Rep (2014)

Bottom Line: On the fourth hospital day, the patient died of multiorgan failure and disseminated intravascular coagulation.Postmortem studies revealed fat emboli in the systemic circulation, ie, fat embolism syndrome.Diagnosing fat embolism syndrome can be difficult in patients on dialysis or in those with collagen vascular or pulmonary diseases.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology and Rheumatology, Department of Internal Medicine, University School of Medicine, Nagakute, Aichi, 480-1195, Japan.

ABSTRACT
A 66-year-old woman receiving continuous ambulatory peritoneal dialysis developed acute respiratory distress 12 hours after a fall. Blood gas analysis revealed hypoxia (PaO2 67.7 torr) and metabolic acidosis with an increased anion gap, consistent with lactic acidosis (lactate, 86.5 mg/dL; normal range, 4.0-16.0). Magnetic resonance imaging showed a lumbar vertebral body fracture. On the fourth hospital day, the patient died of multiorgan failure and disseminated intravascular coagulation. Postmortem studies revealed fat emboli in the systemic circulation, ie, fat embolism syndrome. Diagnosing fat embolism syndrome can be difficult in patients on dialysis or in those with collagen vascular or pulmonary diseases.

No MeSH data available.


Related in: MedlinePlus

(A) Chest X-rays. A large homogenous shadow in the right upper and middle lung fields and a reticular shadow are present in the left middle lung field. (B) Computed tomography (CT) of the chest. Massive infiltration of the right middle lung field was observed. (C) Sagittal T1 weighted magnetic resonance imaging (MRI) of the lumbar spine. A vertebral body fracture was found at the level of L1 (white arrows). (D) Postmortem pathological studies. Fat emboli including bone marrow cells were observed in the pulmonary artery (HE stain, 100×). (E) Postmortem pathological studies. Bone marrow cells were present in an arteriole in the submucosa of the colon (HE stain, 400×). (F) Postmortem pathological studies. Higher magnification of the same section showed many myelocytes and erythroblasts (HE stain, 1000×).
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f1-ccrep-7-2014-007: (A) Chest X-rays. A large homogenous shadow in the right upper and middle lung fields and a reticular shadow are present in the left middle lung field. (B) Computed tomography (CT) of the chest. Massive infiltration of the right middle lung field was observed. (C) Sagittal T1 weighted magnetic resonance imaging (MRI) of the lumbar spine. A vertebral body fracture was found at the level of L1 (white arrows). (D) Postmortem pathological studies. Fat emboli including bone marrow cells were observed in the pulmonary artery (HE stain, 100×). (E) Postmortem pathological studies. Bone marrow cells were present in an arteriole in the submucosa of the colon (HE stain, 400×). (F) Postmortem pathological studies. Higher magnification of the same section showed many myelocytes and erythroblasts (HE stain, 1000×).

Mentions: X-rays of the chest, abdomen, and pelvis revealed a large homogenous shadow in the right upper and middle lung fields and a reticular shadow in the left middle lung field (Fig. 1A) and no evidence of pelvic fractures. Computed tomography (CT) of the chest revealed massive infiltration of the right middle lung field (Fig. 1B).


Fat embolism syndrome: an autopsy-proven case involving a patient on dialysis and systemic scleroderma.

Nishimura N, Banno S, Kimura Y, Maeda S, Kobayashi M, Kawai K, Suga N, Suzuki K, Miura N, Yokoi T, Imai H - Clin Med Insights Case Rep (2014)

(A) Chest X-rays. A large homogenous shadow in the right upper and middle lung fields and a reticular shadow are present in the left middle lung field. (B) Computed tomography (CT) of the chest. Massive infiltration of the right middle lung field was observed. (C) Sagittal T1 weighted magnetic resonance imaging (MRI) of the lumbar spine. A vertebral body fracture was found at the level of L1 (white arrows). (D) Postmortem pathological studies. Fat emboli including bone marrow cells were observed in the pulmonary artery (HE stain, 100×). (E) Postmortem pathological studies. Bone marrow cells were present in an arteriole in the submucosa of the colon (HE stain, 400×). (F) Postmortem pathological studies. Higher magnification of the same section showed many myelocytes and erythroblasts (HE stain, 1000×).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3921132&req=5

f1-ccrep-7-2014-007: (A) Chest X-rays. A large homogenous shadow in the right upper and middle lung fields and a reticular shadow are present in the left middle lung field. (B) Computed tomography (CT) of the chest. Massive infiltration of the right middle lung field was observed. (C) Sagittal T1 weighted magnetic resonance imaging (MRI) of the lumbar spine. A vertebral body fracture was found at the level of L1 (white arrows). (D) Postmortem pathological studies. Fat emboli including bone marrow cells were observed in the pulmonary artery (HE stain, 100×). (E) Postmortem pathological studies. Bone marrow cells were present in an arteriole in the submucosa of the colon (HE stain, 400×). (F) Postmortem pathological studies. Higher magnification of the same section showed many myelocytes and erythroblasts (HE stain, 1000×).
Mentions: X-rays of the chest, abdomen, and pelvis revealed a large homogenous shadow in the right upper and middle lung fields and a reticular shadow in the left middle lung field (Fig. 1A) and no evidence of pelvic fractures. Computed tomography (CT) of the chest revealed massive infiltration of the right middle lung field (Fig. 1B).

Bottom Line: On the fourth hospital day, the patient died of multiorgan failure and disseminated intravascular coagulation.Postmortem studies revealed fat emboli in the systemic circulation, ie, fat embolism syndrome.Diagnosing fat embolism syndrome can be difficult in patients on dialysis or in those with collagen vascular or pulmonary diseases.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology and Rheumatology, Department of Internal Medicine, University School of Medicine, Nagakute, Aichi, 480-1195, Japan.

ABSTRACT
A 66-year-old woman receiving continuous ambulatory peritoneal dialysis developed acute respiratory distress 12 hours after a fall. Blood gas analysis revealed hypoxia (PaO2 67.7 torr) and metabolic acidosis with an increased anion gap, consistent with lactic acidosis (lactate, 86.5 mg/dL; normal range, 4.0-16.0). Magnetic resonance imaging showed a lumbar vertebral body fracture. On the fourth hospital day, the patient died of multiorgan failure and disseminated intravascular coagulation. Postmortem studies revealed fat emboli in the systemic circulation, ie, fat embolism syndrome. Diagnosing fat embolism syndrome can be difficult in patients on dialysis or in those with collagen vascular or pulmonary diseases.

No MeSH data available.


Related in: MedlinePlus