Ketata W, Msaad S, Bahloul N, Marouen F, Ayoub A
Service de pneumo-allergologie, CHU Hédi Chaker, Sfax, Tunisie.
Rev Mal Respir. 2010 Nov;27(9):1109-13. doi: 10.1016/j.rmr.2010.09.016. Epub 2010 Oct 18.
Fat embolism syndrome is a severe complication of long bone fractures, corresponding to the obstruction of small vessels by microdroplets of fat, originating from medulla ossium. Pulmonary involvement, present in 90% cases, makes the severity of the disease.
We report the case of a 22-year-old man who presented, two days after industrial accident causing an opened tibial fracture, acute dyspnea with hemoptysis. Angio-CT-scan didn't show any proximal vascular obstruction, but parenchymal sections showed diffuse, bilateral and multifocal hyperdensities predominating at the periphery. Broncho-alveolar lavage brought a hemorrhagic liquid, with a high macrophage content and lipid inclusions in macrophages. Exams for the etiologic diagnosis of intra-alveolar hemorrhage were negative: renal function, 24-hour proteinuria, antinuclear antibodies, antineutrophil cytoplasmic antibodies. The diagnosis of intra-alveolar hemorrhage secondary to fat embolism was established. The outcome was spontaneously favorable.
The occurrence of intra-alveolar hemorrhage in the course fat embolism is rarely reported. Its pathogenic mechanisms are not understood. It is mandatory to eliminate the other causes of alveolar hemorrhage before holding the diagnosis of fat embolism. Treatment is only symptomatic, based on respiratory reanimation.
脂肪栓塞综合征是长骨骨折的一种严重并发症，是由源自骨髓的脂肪微滴阻塞小血管所致。肺部受累见于90%的病例，决定了该病的严重程度。
我们报告一例22岁男性病例，该患者在因工业事故导致开放性胫骨骨折两天后出现急性呼吸困难并咯血。血管CT扫描未显示任何近端血管阻塞，但实质切片显示弥漫性、双侧性和多灶性高密度影，以周边为主。支气管肺泡灌洗引出血性液体，巨噬细胞含量高，巨噬细胞内有脂质包涵体。肺泡内出血病因诊断检查结果均为阴性：肾功能、24小时蛋白尿、抗核抗体、抗中性粒细胞胞浆抗体。确诊为脂肪栓塞继发肺泡内出血。结果为自发好转。
脂肪栓塞过程中发生肺泡内出血的情况鲜有报道。其发病机制尚不清楚。在诊断脂肪栓塞之前，必须排除肺泡出血的其他原因。治疗仅为对症治疗，以呼吸复苏为基础。
