Diagnostic Tools of Fat Embolism Syndrome in Trauma

Original Article

Journal of the Korean Society of Traumatology 2002;15(1):22-27.

Ryuk Ahn, M.D., Kyoung-Soo Lim, M.D., Won Kim, M.D., Won Young Kim, M.D., and Youn-Baik Choi, M.D.*

Department of Emergency Medicine and Surgery^*
Asan Medical Center

외상성 지방색전증 증후군의 진단방법

안력·임경수·김원·김원영·최윤백*

울산대학교 의과대학 서울아산병원 응급의학교실, 외과학교실*

Abstract

Purpose
: The purpose of this research is to estimate the diagnostic tool of fat embolism syndrome (FES) in trauma patients with long bone fracture and to compare the accuracy as a diagnostic tool. Methods : We retrospectively reviewed the medical records of 17 patients in whom FES was diagnosed from August 1, 1989, to March 31, 2002. The clinical symptoms and signs of FES were analyzed, and the result of radiologic studies, such as lung perfusion scans, pulmonary venography, thromboembolic CT scans, brain CT scans, brain diffusion MRI, were evaluated. Results : In evaluating the fracture patterns, 11 patients (65%) had multiple long-bone fractures and 6 patients (35%) had a single long-bone fracture. The diagnosis of FES was made by using Gurd’s clinical criteria including hypoxia: 17 patients (100%); mental status changes, 13 patients (76%); thrombocytopenia, 12 patients (71%); petechiae, 4 patients (24%); fever, 8 patients (47%); unexplained anemia, 14 patients (82%); and tachycardia, 10 patients (59%). The diagnostic accuracy of radiologic tools were as follows: only one case showed pulmonary embolism in a lung perfusion scan, but other studies, such as pulmonary venography and a thromboembolism CT scans were negative. The brain CT scan did not show abnormal findings, but one case of brain diffusion MRI showed an embolic brain lesion. Conclusion : We conclude that FES remains a diagnosis of exclusion based on clinical criteria. Radiologic tools do not effectively show embolic lesions of the lung or brain.

Key Words: Fat embolism syndrome; Lung perfusion scan; Brain CT scan; Brain MRI