Nichols G R, Corey T S, Davis G J
Department of Pathology, University of Louisville School of Medicine, KY.
J Forensic Sci. 1990 Mar;35(2):493-9.
Fatal fat embolism is usually thought of as a sequel to long-bone fracture, although cases secondary to soft tissue injury and atraumatic conditions have been infrequently reported. In this case of a two-year-old child-abuse victim who sustained multiple blunt traumatic injuries without skeletal fractures, pulmonary and systemic (brain and kidney) fat emboli were identified. At autopsy, all thoracic and abdominal viscera were intact; cranial contents exhibited only diffuse symmetrical petechial hemorrhages of the white matter. Because of the severe and widespread nature of soft tissue hemorrhage, and the absence of a grossly discernible cause of death, fat embolism was suspected. Using a combination of frozen section with oil red O staining and formalin-fixed osmium stained tissues, the immediate cause of death was determined to be diffuse fat embolism. Review of the literature reveals a pathophysiologic basis for fat embolism in the absence of fracture, both as a consequence of an acute increase in local pressure at the site of trauma and an alteration of the emulsification of blood lipids during shock. In light of these findings, we present this case to remind the forensic science community to consider fat embolism as the cause of death in cases of blunt-force injury without fracture.
致命性脂肪栓塞通常被认为是长骨骨折的后遗症，尽管继发于软组织损伤和无创伤情况的病例报道较少。在本例中，一名两岁受虐儿童遭受多处钝器创伤但无骨骼骨折，经鉴定存在肺和全身（脑和肾）脂肪栓塞。尸检时，所有胸腹部脏器均完好无损；颅脑内容物仅显示白质弥漫性对称性瘀点出血。由于软组织出血严重且广泛，且无明显的死因，故怀疑为脂肪栓塞。通过冷冻切片油红O染色和福尔马林固定锇染色组织相结合的方法，确定直接死因是弥漫性脂肪栓塞。文献回顾揭示了在无骨折情况下脂肪栓塞的病理生理基础，这既是创伤部位局部压力急性增加的结果，也是休克期间血脂乳化改变的结果。鉴于这些发现，我们呈现此病例以提醒法医学界在无骨折的钝器伤病例中考虑脂肪栓塞作为死因。
