Fatal bone marrow embolism

Abstract

A 45-year-old man presented to the emergency department with fever, hypotension, respiratory distress, and altered mental status. Imaging revealed a femoral fracture and arterial blood gas showed severe metabolic acidosis. He died soon after admission. An autopsy revealed bone marrow particles in the lumen of numerous pulmonary arteries as well as fat emboli with admixed scattered hematopoietic cells in small vessels of the heart and liver. A clinical diagnosis of bone marrow embolism may be challenging due to its obscure presentation with possible multiorgan involvement. A definitive diagnosis is usually established postmortem with histopathological analysis of tissue collected during autopsy.

Keywords: Autopsy; bone marrow embolism; fat embolism; fat embolism syndrome; respiratory failure.

Figure 1.

Microscopic examination of the lung showing (a) brightly eosinophilic hyaline membranes and intraalveolar hemorrhage (hematoxylin and eosin [H&E], 200×), with (b–e) the lumen of numerous vessels completely or partially occupied by bone marrow particles (b, H&E, 200×; c–e, H&E, 400×). Microscopic examination of the (f) liver and (g, h) heart showing fat emboli with admixed hematopoietic cells (H&E, 200× and 400×).