Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada.
JBJS Case Connect. 2020 Oct-Dec;10(4):e20.00127. doi: 10.2106/JBJS.CC.20.00127.
A 29-year-old motor vehicle collision passenger presented with fractures of the pelvic ring, bilateral femurs, and right tibia/fibula. All fractures were stabilized with external fixation and fixed definitively 48 hours later. Postoperatively, the patient suffered rapid clinical decline. Emergent head computed tomography (CT) demonstrated tonsillar herniation with loss of gray-white matter differentiation. Although respiratory status remained uncompromised throughout presentation, pathology revealed extensive cerebral fat embolism.
Fat embolism can traverse the lungs without eliciting an inflammatory response, radiographic infiltrate, or impairing gas exchange. This may lead to a clinically silent, fatal cerebral fat embolism in an intubated, sedated patient.
一名 29 岁机动车碰撞乘客出现骨盆环、双侧股骨和右胫腓骨骨折。所有骨折均采用外固定架固定，48 小时后行确定性固定。术后，患者病情迅速恶化。急诊头颅 CT 显示扁桃体疝，灰白质分界消失。尽管整个发病过程中呼吸状态保持不受影响，但病理显示广泛的脑脂肪栓塞。
脂肪栓塞可穿过肺部而不引起炎症反应、放射状浸润或损害气体交换。这可能导致插管镇静患者发生临床无症状、致命性脑脂肪栓塞。
