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9 "Embolism"
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Original Article
Epidemiology and clinical characteristics of posttraumatic hospitalized patients with symptoms related to venous thromboembolism: a single-center retrospective study
Hyung Su Park, Sung Youl Hyun, Woo Sung Choi, Jin-Seong Cho, Jae Ho Jang, Jea Yeon Choi
J Trauma Inj. 2022;35(3):159-167.   Published online June 10, 2022
DOI: https://doi.org/10.20408/jti.2021.0052
  • 1,921 View
  • 61 Download
AbstractAbstract PDF
Purpose
The aim of this study was to investigate the epidemiology of trauma inpatients with venous thromboembolism (VTE) symptoms diagnosed using computed tomographic angiography (CTA) in Korea
Methods
In total, 7,634 patients admitted to the emergency department of Gachon University Gil Medical Center, a tertiary hospital, and hospitalized between July 1, 2018 and December 31, 2020 were registered for this study. Of these patients, 278 patients who underwent CTA were enrolled in our study.
Results
VTE was found in 120 of the 7,634 patients (1.57%), and the positive diagnosis rate of the 278 patients who underwent CTA was 43.2% (120 of 278). The incidence of VTE was statistically significantly higher among those with severe head and neck injuries (Abbreviated Injury Scale, 3–5) than among those with nonsevere head and neck injuries (Abbreviated Injury Scale, 0–2; P=0.038). In a subgroup analysis, the severe and nonsevere head and neck injury groups showed statistically significant differences in known independent risk factors for VTE. In logistic regression analysis, the adjusted odds ratio of severe head and neck injury (Abbreviated Injury Scale, 3–5) for VTE was 1.891 (95% confidence interval, 1.043–3.430).
Conclusions
Trauma patients with severe head and neck injuries are more susceptible to VTE than those with nonsevere head and neck injuries. Thus, physicians must consider CTA as a priority for the diagnosis of VTE in trauma patients with severe head and neck injuries who show VTE-associated symptoms.
Summary
Case Reports
Cerebral Fat Embolism That Was Initially Negative on DiffusionWeighted Magnetic Resonance Imaging
Seung Je Go, Yun Su Mun, Seung Ho Bang, Yong Han Cha, Young Hoon Sul, Jin Bong Ye, Jae Guk Kim
J Trauma Inj. 2021;34(2):126-129.   Published online March 22, 2021
DOI: https://doi.org/10.20408/jti.2020.0007
  • 3,037 View
  • 76 Download
AbstractAbstract PDF

Fat embolism syndrome is a rare, but serious condition that occurs in patients with fractures of the long bones or who undergo orthopedic surgery. The main clinical features of fat embolism syndrome are an altered mental status, hypoxia, and petechial rash. Cerebral fat embolism is the most severe manifestation of fat embolism syndrome because it can lead to an altered mental status. The diagnosis of cerebral fat embolism is clinical, but brain magnetic resonance image (MRI) is helpful. There is usually an interval until symptoms, such as an altered mental status, develop after trauma. We report a case of cerebral fat embolism in which the patient’s mental status deteriorated several hours after trauma and the initial findings were negative on diffusion-weighted MRI.

Summary
Pulmonary Thromboembolism during Acetabular Fracture Operation
Il Seo, Chang-Wug Oh, Joon-Woo Kim, Kyeong-Hyun Park
J Trauma Inj. 2018;31(2):72-75.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.72
  • 4,113 View
  • 81 Download
AbstractAbstract PDF

Acetabular and Pelvic ring fractures are major high-energy trauma injuries and are often combined with other injuries. In particular, cause of long duration of immobilization and combined injuries, venous thromboembolism is a common complication in trauma patients with pelvic or acetabular fractures. We report a case of a fatal pulmonary thromboembolism during the acetabulum fracture operation in a 62-year-old male patient.

Summary
Rare Imaging of Fat Embolism Seen on Computed Tomography in the Common Iliac Vein after Polytrauma
Hojun Lee, Jonghwan Moon, Junsik Kwon, John Cook-Jong Lee
J Trauma Inj. 2018;31(2):103-106.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.103
  • 4,405 View
  • 58 Download
  • 1 Citations
AbstractAbstract PDF

Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. However, early diagnosis of fat embolism is very difficult because the embolism usually does not show at the computed tomography as a large fat complex within vessels. Forty-eight-year-old male with pedestrian traffic accident ransferred from a local hospital by helicopter to the regional trauma center by two flight surgeons on board. At the rendezvous point, he had suffered with dyspnea without any airway obstruction sign with 90% of oxygen saturation from pulse oximetry with giving 15 L of oxygen by a reserve bag mask. The patient was intubated at the rendezvous point. The secondary survey of the patient revealed multiple pelvic bone fracture with sacrum fracture, right femur shaft fracture and right tibia head fracture. Abdominal computed tomography was performed in 191 minutes after the injury and fat embolism with Hounsfield unit of ?86 in his right common iliac vein was identified. Here is a very rare case that mass of fat embolism was shown within common iliac vein detected in computed tomography. Early detection of the fat embolus and early stabilization of the fractures are essential to the prevention of sequelae such as cerebral fat embolism.

Summary

Citations

Citations to this article as recorded by  
  • Fat embolism in the popliteal vein detected on CT: Case report and review of the literature
    Tucker Burr, Hamza Chaudhry, Cheryl Zhang, Vasilios Vasilopoulos, Emad Allam
    Radiology Case Reports.2020; 15(11): 2308.     CrossRef
Fat Embolism Syndrome - Three Case Reports and Review of the Literature
Leonidas Grigorakos, Ioannis Nikolopoulos, Stamatina Stratouli, Anastasia Alexopoulou, Eleftherios Nikolaidis, Eleftherios Fotiou, Daria Lazarescu, Ioannis Alamanos
J Trauma Inj. 2017;30(3):107-111.   Published online October 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.3.107
  • 2,988 View
  • 67 Download
  • 1 Citations
AbstractAbstract PDF
The fat embolism syndrome (FES) represents a condition, usually with traumatic etiology, which may pose challenges to diagnosis while its treatment usually requires supportive measures in the intensive care units (ICUs). The clinical criteria, including respiratory and cerebral dysfunction and a petechial rash, along with imaging studies help in diagnosis. Here we present three case reports of young male who developed FES and were admitted to our ICUs after long bones fractures emerging after vehicle crashes and we briefly review FES literature. All patients' treatment was directed towards: 1) the restoration of circulating volume with fresh blood and/or plasma; 2) the correction of acidosis; and 3) immobilization of the affected part. All patients recovered and were released to the orthopedic wards. The incidence of cases of patients with FES admitted in our ICUs records a significant decrease. This may be explained in terms effective infrastructure reforms in Greece which brought about significant improvement in early prevention and management.
Summary

Citations

Citations to this article as recorded by  
  • Late-onset isolated cerebral fat embolism syndrome after a simple tibial plateau fracture: a rare case report
    Ta-Li Hsu, Tien-Chi Li, Fei-Pi Lai, Ming Ouhyoung, Chih-Hung Chang, Cheng-Tzu Wang
    Journal of International Medical Research.2021; 49(7): 030006052110284.     CrossRef
Pulmonary Bone Cement Embolism Following Percutaneous Vertebroplasty
Yong Han Cha
J Trauma Inj. 2015;28(3):202-205.   Published online September 30, 2015
DOI: https://doi.org/10.20408/jti.2015.28.3.202
  • 1,819 View
  • 6 Download
  • 1 Citations
AbstractAbstract PDF
PURPOSE
Pulmonary cement embolization after vertebroplasty is a well-known complication. The reported incidence of pulmonary cement emboli after vertebroplasty ranges frome 2.1% to 26% with much of this variation resulting from which radiographic technique is used to detect embolization. Onset and severity of symptoms are variable.
CASE
DESCRIPTION: We present the case of a 83-year-old women who underwent fourth lumbar vertebroplasty and subsequently had dyspnea several days later. Posteroanterior chest radiography showed multiple linear densities. Computed tomography of thorax revealed also multiple bilateral, linear hyperdensities within the lobar pulmonary artery branches are detected in axial and coronal views. LITERATURE REVIEWS: Operative management of vertebral compression fractures has included percutaneous vetebroplasty for the past 25 years. Symptoms of pulmonary cement embolism can occur during procedure, but more commonly begin days to weeks, even months, after vertebroplsty. Most cases of pulmonary cement emboli with cardiovascular and pulmonary complications are treated nonoperatively with anticoagulation. Endovascular removal of large cement emboli from the pulmonary arteries is not without risk and sometimes requires open surgery for complete removal of cement pieces.
CONCLUSION
Pulmonary cement embolism is a potentially serious complication of vertebroplasty. If a patient has chest pain or respiratory difficulty after the procedure, chest radiography and possibly advanced chest imaging studies should be performed immediately.
Summary

Citations

Citations to this article as recorded by  
  • Micro- and Nanoparticulate Hydroxyapatite Powders as Fillers in Polyacrylate Bone Cement—A Comparative Study
    Anna Sobczyk-Guzenda, Paulina Boniecka, Anna Laska-Lesniewicz, Marcin Makowka, Hieronim Szymanowski
    Materials.2020; 13(12): 2736.     CrossRef
Fatal Pulmonary Thromboembolism after a Pelvic Ring Injury: A Case Report
Joon Woo Kim, Chang Wug Oh, Hyung Sub Kim, Hee June Kim
J Trauma Inj. 2014;27(4):224-228.
  • 1,183 View
  • 11 Download
AbstractAbstract PDF
Pelvic ring and acetabular fractures are major high-energy trauma injuries and are often associated with other injuries or fractures. In particular, a venous thromboembolism is an important common complication in trauma patients with pelvic or acetabular fractures. We report a case of a fatal pulmonary thromboembolism after a pelvic fracture in a 60-year-old female patient.
Summary
Original Article
Incidence of Venous Thromboembolism in Pelvic and Acetabular Fractures in the Korean Population
Sang Ki Lee, Jae Won Lee, Jung Joo Hwang
J Trauma Inj. 2013;26(3):74-80.
  • 1,098 View
  • 5 Download
AbstractAbstract PDF
PURPOSE
There are no detailed reports on the incidence of venous thromboembolism (VTE) in pelvic and acetabular fractures in the Asian population. The purpose of this study was to investigate the incidence of VTE in pelvic and acetabular fractures in the Korean population.
METHODS
The cases of 67 Korean patients with pelvic and acetabular fractures treated at our hospital from January 2009 to February 2012 were analyzed retrospectively. Until May 2010, VTE screening was performed by contrast-enhanced computed tomography (CT) or ultrasonography (US) when the D-dimer value did not decline predictably, still exceeded 20 microg/ml at 5 days after trauma and surgery, or increased to greater than 20 microg/ml after a period of decline. After May 2010, contrast-enhanced CT and US were performed routinely irrespective of the D-dimer value. Physical prophylaxis was performed on all patients. The effects of the presence of a pelvic and/or acetabular fracture, and the effects of fracture type, accompanying injuries, and screening strategies on the incidences of VTE were investigated.
RESULTS
Overall, 26 patients(38.8%) were diagnosed with VTE and PTE in 14(20.9%). All were asymptomatic. Significantly higher incidences of VTE and PTE were observed in trauma patients with pelvic and acetabular fractures than in trauma patients without pelvic and acetabula fractures treated during the same period. No significant differences were observed in the incidences of VTE and PTE between patients with pelvic fractures, and patients with acetabular fractures or between patients with and without accompanying injuries. Compared with the previous screening strategy, the detection rates for VTE and PTE were higher for the newer screening strategy; however, the difference did not reach statistical significance.
CONCLUSION
In the Korean population, we should be vigilant for a high incidence of VTE, especially PTE, in patients with pelvic and acetabular fractures.
Summary
Case Report
Cerebral Fat Embolism after Traumatic Multiple Fracture: A Case Report
Ho Hyun Kim, Yun Chul Park, Dong Kyu Lee, Chan Yong Park, Jae Hun Kim, Yeong Dae Kim, Jung Chul Kim
J Trauma Inj. 2013;26(2):58-62.
  • 1,188 View
  • 8 Download
AbstractAbstract PDF
A cerebral fat embolism is an uncommon but serious complication of long bone fracture. It can be fatal, and early detection is not easy. Neurologic symptoms are variable, and the clinical diagnosis is difficult. The pathogenesis remains controversial, and several theories have been proposed. Magnetic resonance imaging can detect a cerebral fat embolism with a higher sensitivity than cerebral computed tomography. We report a case of a post-traumatic cerebral fat embolism without pulmonary involvement and review the existing literature.
Summary

J Trauma Inj : Journal of Trauma and Injury