Cuculić Drazen, Stemberga Valter, Coklo Miran, Sosa Ivan, Stifter Sanja, Bosnar Alan
Department of Forensic Medicine, School of Medicine, Rijeka University, Rijeka, Croatia.
Coll Antropol. 2010 Jun;34(2):723-6.
The fat embolism syndrome (FES) in forensic practice is observed usually in cases of polytrauma related deaths. FES is rare, but serious complication after trauma. The most cases of post traumatic fat embolism are not fatal and it's very likely that many cases of mild fat embolism are overlooked. We describe a case of fat embolism syndrome in a young man after high energy injury. Upon concrete ceiling fell on his shoulders he had open fractures of both tibias and massive haematoma of the left hip joint. Transport immobilization of both legs was performed with admitting of analgesia during transportation to the hospital. Immediately after admission to hospital he underwent surgery. Several hours after osteosynthesis of both tibias, in ICU patient became hemodinamically and respiratory unstable. He developed global cyanosis and metabolic acidosis with significant decrease of oxygen pressure in the blood. Control chest radiograph showed typical "snow-storm" like pulmonary infiltrations. Deep bradicardy occurred followed by cardiopulmonary arrest. CPR was unsuccessful and the patient suddenly died within 12 hours from the incident. Histologic confirmation of fatty droplets the most commonly observed in the lung capillaries, brain capillaries or disseminated throughout the body remains diagnostic standard. We present one case of FES to emphasize the arising need of a quantitative analysis of both the size and localization of the fat emboli in order to grade the severity of FES and its relative contribution in pathophysiology of death. The postmortem diagnosis of fat embolism syndrome (FES), traditionally based on the histological demonstration of fat globules seems not to be enough, nowadays. A quantitative analysis of both the size and localization of the fat emboli has been discussed as reliable method of grading the pulmonary fat embolism in order to determine its relative functional contribution in death pathogenesis.
在法医实践中，脂肪栓塞综合征（FES）通常见于多发伤相关死亡病例。FES虽罕见，但却是创伤后严重的并发症。创伤后脂肪栓塞的大多数病例并非致命，很可能许多轻度脂肪栓塞病例被忽视了。我们描述了一名年轻男性在高能损伤后发生脂肪栓塞综合征的病例。当混凝土天花板砸在他肩上时，他双侧胫骨开放性骨折，左髋关节大量血肿。在送往医院的途中对双腿进行了固定运输，并给予了止痛治疗。入院后他立即接受了手术。双侧胫骨骨固定术后数小时，患者在重症监护病房出现血流动力学和呼吸不稳定。他出现全身发绀和代谢性酸中毒，血氧分压显著降低。胸部X线对照检查显示典型的“暴风雪”样肺部浸润。随后出现深度心动过缓，继而心跳呼吸骤停。心肺复苏未成功，患者在事件发生后12小时内突然死亡。肺毛细血管、脑毛细血管或全身弥漫性出现最常见的脂肪滴的组织学证实仍是诊断标准。我们报告一例FES病例，以强调对脂肪栓子的大小和定位进行定量分析的必要性，以便对FES的严重程度及其在死亡病理生理学中的相对作用进行分级。传统上基于脂肪球组织学表现的脂肪栓塞综合征（FES）的尸检诊断如今似乎并不充分。对脂肪栓子的大小和定位进行定量分析已被视为对肺脂肪栓塞进行分级的可靠方法，以便确定其在死亡发病机制中的相对功能作用。
