Oda Keishi, Kawanami Toshinori, Yatera Kazuhiro, Ogoshi Takaaki, Kozaki Minako, Nagata Shuya, Nishida Chinatsu, Yamasaki Kei, Ishimoto Hiroshi, Mukae Hiroshi
Department of Respiratory Medicine, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
J UOEH. 2011 Sep 1;33(3):255-61. doi: 10.7888/juoeh.33.255.
A 78 year old Japanese woman was transferred to our hospital for the treatment of a fracture of the left femoral neck in April, 2010. She had been taking oral corticosteroid (prednisolone 5 mg/day) for the treatment of idiopathic interstitial pneumonia since 2003, and had been treated by home oxygen therapy since 2007. She fell in the restroom at home and hurt herself, and was transferred to our hospital for treatment of a left femoral neck fracture in April, 2010. Her respiratory status was stable just after the transfer; however, she was transferred to the intensive care unit and started to receive mechanical ventilation due to rapidly progressive respiratory failure on the fourth day after admission. Chest X-ray and computed tomography revealed rapid progression of bilateral ground-glass attenuations, and acute exacerbation of interstitial pneumonia was clinically suspected. However, the elevation of D-dimer over time and characteristic findings of petechial hemorrhagic lesions on her palpebral conjunctivae and neck with microscopic findings of phagocytized lipid in alveolar macrophages in her endobronchial secretion led to the diagnosis of fat embolism syndrome. She was successfully treated with high-dose corticosteroid and sivelestat sodium, and she was discharged on the 21st day after admission. Although a differential diagnosis of acute exacerbation of interstitial pneumonia and fat embolism syndrome was necessary and difficult in the present case, characteristic findings of petechial hemorrhagic lesions of skin, palpebral conjunctiva and lipid-laden alveolar macrophages in endotracheal aspirate were useful for the accurate and prompt diagnosis of fat embolism syndrome.
2010年4月，一名78岁的日本女性因左侧股骨颈骨折被转至我院治疗。自2003年起，她一直口服皮质类固醇（泼尼松龙5毫克/天）治疗特发性间质性肺炎，自2007年起接受家庭氧疗。她在家中卫生间摔倒受伤，于2010年4月被转至我院治疗左侧股骨颈骨折。转院后她的呼吸状况起初稳定；然而，入院后第四天，由于迅速进展的呼吸衰竭，她被转至重症监护病房并开始接受机械通气。胸部X光和计算机断层扫描显示双侧磨玻璃影迅速进展，临床上怀疑为间质性肺炎急性加重。然而，D - 二聚体随时间升高，以及她睑结膜和颈部出现特征性的瘀点出血性病变，同时支气管分泌物中肺泡巨噬细胞有吞噬脂质的微观表现，最终诊断为脂肪栓塞综合征。她接受了大剂量皮质类固醇和西维来司他钠治疗并获成功，入院后第21天出院。尽管在本病例中鉴别间质性肺炎急性加重和脂肪栓塞综合征既必要又困难，但皮肤、睑结膜瘀点出血性病变以及气管内吸出物中充满脂质的肺泡巨噬细胞的特征性表现，有助于准确、迅速地诊断脂肪栓塞综合征。
