Niimi A, Kobayashi H, Sugita T, Minakata Y, Horikawa S, Suzuki Y, Nishiyama H, Maekawa N, Kinoshita T, Wataya S
Department of Respiratory Disease, Wakayama Red Cross Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1990 Feb;28(2):362-7.
On the basis of the studies of autopsy cases and experimental animals, the pulmonary pathological findings of fat embolism syndrome (FES) have been reported to be (1) fat globules in the alveolar capillaries and the alveoli, (2) intra-alveolar hemorrhage, (3) alveolar edema and (4) foci of secondary infection. However, reports on lung biopsy in FES are rare, and no report has mentioned bronchoalveolar lavage (BAL) in FES. We experienced a case of FES, in which BAL was diagnostic. A 23 year-old man traffic accident victim was brought to our hospital by ambulance. His consciousness was clear and skeletal X-ray films revealed multiple fractures of the right femur, left tibia and left fibula. Direct traction of bilateral lower extremities was done. He remained stable subjectively, but anemia and thrombocytopenia progressed gradually in spite of blood transfusion. On the 4th hospital day severe hypoxemia, diffuse pulmonary infiltrates and petechiae in bilateral axillary lesions appeared, and FES was strongly suspected. O2 inhalation by face mask and high dose methylprednisolone administration was started. The hypoxemia improved, but pulmonary infiltrates worsened. For differential diagnosis, bronchoscopy and BAL was done on the 7th hospital day. Bronchoscopy revealed much fresh blood in the left main, upper lobe and lower lobe bronchus but no bleeding point was found. BAL fluid was bloody. The Sudan III stain and Berlin blue stain revealed several fat globules and numerous hemosiderin-laden macrophages. The presence of intra-alveolar fat globules and intra-alveolar hemorrhage was proved and definite diagnosis of FES was established.
基于尸检病例和实验动物的研究，脂肪栓塞综合征（FES）的肺部病理表现据报道为：（1）肺泡毛细血管和肺泡内的脂肪球；（2）肺泡内出血；（3）肺泡水肿；（4）继发性感染灶。然而，关于FES肺活检的报道很少，且尚无报道提及FES中的支气管肺泡灌洗（BAL）。我们遇到一例FES，其中BAL具有诊断价值。一名23岁男性交通事故受害者由救护车送至我院。他意识清醒，骨骼X线片显示右股骨、左胫骨和左腓骨多处骨折。对双下肢进行了直接牵引。他主观上保持稳定，但尽管输血，贫血和血小板减少仍逐渐加重。入院第4天，出现严重低氧血症、双肺弥漫性浸润及双侧腋窝病变处瘀点，强烈怀疑为FES。开始面罩吸氧并给予大剂量甲基强的松龙。低氧血症有所改善，但肺部浸润加重。为进行鉴别诊断，于入院第7天行支气管镜检查及BAL。支气管镜检查显示左主支气管、上叶支气管和下叶支气管有大量新鲜血液，但未发现出血点。BAL液呈血性。苏丹III染色和柏林蓝染色显示有多个脂肪球和大量含铁血黄素巨噬细胞。证实了肺泡内脂肪球和肺泡内出血的存在，确立了FES的明确诊断。
