Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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September 4, 2014
Fat Embolism
- Background: Following a bony fracture or a surgical manipulation, marrow fat gains access to systemic venous circulation, resulting in multiple small emboli to pulmonary arterioles.
- Brain fat embolism can occur in the absence of right-to-left heart shunt, as fat emboli can pass through the pulmonary vasculature, resulting in systemic embolization.
- Clinical Presentation: Delayed onset of stupor following bone fracture is typical. Skin or retinal petechiae maybe seen.
- Key Diagnostic Features:
- Multiple scattered foci of restricted diffusion signals in the subcortical regions are characteristic of fat embolism (“starfield” pattern).
- In addition, as illustrated here, hypoxic injury with bilateral globus pallidi involvement maybe seen if there is pulmonary emboli with respiratory distress.
- DDx:
- Susac syndrome
- Vasculitis
- Multiple sclerosis
- Thrombotic thrombocytopenic purpura
- Rx: Supportive care and ventilatory assistance, if needed.
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