Adi Osman, Fong Chan Pei, Azil Azlizawati, Wahab Shaik Farid Abdul
Department of Trauma and Emergency Medicine, Raja Permaisuri Bainun Hospital, 30450, Ipoh, Perak, Malaysia.
Departments of Emergency Medicine, School of Medical Sciences, University Science of Malaysia (USM), Kubang Kerian, Kelantan, Malaysia.
Ultrasound J. 2019 Feb 25;11(1):1. doi: 10.1186/s13089-019-0116-9.
We report a case study of fat embolism seen on ultrasound at right internal jugular vein during central venous cannulation in a patient diagnosed with fat embolism syndrome. This case demonstrates the importance of ultrasound for evaluation of trauma cases with suspicion of fat embolism.
A 23-year-old trauma patient with closed fracture of left femoral shaft and left humerus presented to our emergency department (ED). 11 h after admission to ED, patient became confused, hypoxic and hypotensive. He was then intubated for respiratory failure and mechanically ventilated. Transesophageal ultrasound revealed hyperdynamic heart, dilated right ventricle with no regional wall abnormalities and no major aorta injuries. Whole-body computed tomography was normal. During central venous cannulation of right internal jugular vein (IJV), we found free floating mobile hyperechoic spots, located at the anterior part of the vein. A diagnosis of fat embolism syndrome later was made based on the clinical presentation of long bone fractures and fat globulin in the blood. Despite aggressive fluid resuscitation, patient was a non-responder and needed vasopressor infusion for persistent shock. Blood aspirated during cannulation from the IJV revealed a fat globule. Patient underwent uneventful orthopedic procedures and was discharged well on day 5 of admission.
Point-of-care ultrasound findings of fat embolism in central vein can facilitate and increase the suspicion of fat embolism syndrome.
我们报告了一例在中心静脉置管过程中，于右侧颈内静脉超声检查发现脂肪栓塞的病例，该患者被诊断为脂肪栓塞综合征。本病例展示了超声在评估疑似脂肪栓塞的创伤病例中的重要性。
一名23岁的创伤患者，左股骨干和左肱骨闭合性骨折，送至我院急诊科。入院11小时后，患者出现意识模糊、低氧血症和低血压。随后因呼吸衰竭行气管插管并机械通气。经食管超声显示心脏高动力状态、右心室扩张，无节段性室壁异常，且无主动脉重大损伤。全身计算机断层扫描结果正常。在右侧颈内静脉中心静脉置管过程中，我们发现静脉前部有游离的可移动高回声斑点。后来根据长骨骨折的临床表现和血液中的脂肪球蛋白诊断为脂肪栓塞综合征。尽管积极进行液体复苏，患者无反应，因持续性休克需要血管活性药物输注。置管时从颈内静脉抽出的血液中发现一个脂肪球。患者接受了顺利的骨科手术，并于入院第5天康复出院。
中心静脉内脂肪栓塞的床旁超声检查结果有助于提高对脂肪栓塞综合征的怀疑。
