Correlation of clinical parameters with imaging findings to confirm the diagnosis of fat embolism syndrome

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 including those of Gurd's and Wilson's although universally used for its diagnosis are not specific. Different methods of imaging are increasingly performed in the patients with presumed FES. The objective of this study is to determine whether there is a correlation between the clinical parameters and the imaging findings in confirming the FES diagnosis.

Methods: Patients admitted with FES were identified from the surgical intensive unit registry and 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 with a 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 all patients with suspected FES by clinical criteria should have imaging studies to confirm the diagnosis.

Keywords: Intramedullary nailing; fat embolism syndrome; hypoxia; imaging studies; neurological deterioration; petechial skin rash.

Figure 1

Etiology of Fat embolism syndrome. Description of primary etiology for fat embolism syndrome in number and the percentage.

Figure 2

Skeletal fractures and associated injuries. Description of long bone skeletal fracture resulting from the primary etiology. It also describes the associated injuries and fractures.

Figure 3

Surgical intervention. In this figure description of the surgical interventions in the patient group resulting in fat embolism syndrome. It also describes the patient developing fat embolism syndrome without any interventions, while waiting for surgery.