Fatal fat embolism syndrome in a young trauma patient with a stable initial presentation: time to define predictive criteria? A case report

Abstract

Fat embolism syndrome (FES) is a rare but serious complication most commonly associated with trauma, particularly long bone fractures. However, symptomatic FES remains a significant diagnostic and therapeutic challenge. We present the case of a 20-year-old man who, after sustaining multiple long bone fractures in a motorcycle accident and initially appearing stable, experienced a rapid and fatal progression of FES. This case underscores the unpredictable course of FES even in young, previously healthy individuals and highlights the critical need for early recognition and intervention. It also emphasizes the importance of identifying risk factors that may predict severe outcomes and mortality.

Keywords: Bone fractures; Case reports; Fat embolism syndrome; Wounds and injuries.

Fig. 1.

The peribronchial regions in the posterobasal areas of both lungs display zones of increased parenchymal density consistent with consolidation, accompanied by accentuated interlobular septa (arrow).

Fig. 2.

Magnetic resonance imaging of the brain. (A–C) T2-weighted imaging. (A) The sagittal view, showing multiple hyperintense lesions, including involvement of the brainstem (red arrow) and confluent lesions in the parieto-occipital region (green arrow). (B) The transverse view, showing scattered punctate foci of cytotoxic edema forming a characteristic “starfield pattern” (green arrow). (C) The transverse view revealing periventricular lesions (green arrow). (D) A transverse view displaying numerous microhemorrhages throughout the white matter on T2 susceptibility-weighted imaging, creating a distinct “walnut kernel pattern.”

Fig. 3.

Characteristic petechiae in the axilla (arrow).

Fig. 4.

Transverse section of the brain postmortem revealing diffuse punctate hemorrhages scattered throughout the white matter (arrows).

Fig. 5.

Sudan-stained sections highlighting fat emboli in red (arrows) within specimens from (A) the brain (×100), (B) the lung (×400), and (C, D) the kidney (×100 and ×400, respectively).