Department of Radiology, Alfred Health, Melbourne, Australia.
Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Australia.
Emerg Radiol. 2022 Feb;29(1):41-47. doi: 10.1007/s10140-021-01969-4. Epub 2021 Aug 19.
Fat embolism syndrome (FES) is a rare complication in trauma patients (usually with long bone fractures) in which migrating medullary fat precipitates multiorgan dysfunction, classically presenting with dyspnoea, petechiae and neurocognitive dysfunction. Although this triad of symptoms is rare, it nonetheless aids diagnosis of pulmonary fat embolism (PuFE). Typical imaging features of PuFE are not established, although increasing use of CT pulmonary angiography (CTPA) in this cohort may provide important diagnostic information. We therefore conducted a case series of FES patients with CTPA imaging at a Level 1 Trauma Centre in Melbourne, Australia.
Medical records and various radiological investigations including CTPA of consecutive patients diagnosed clinically with FES between 2006 and 2018, including demographics, injury and their progress during their admission, were reviewed.
Fifteen FES patients with retrievable CTPAs were included (mean age 31.2 years, range 17-69; 12 males [80%]). 93.3% had long bone fractures. CTPA was performed 2.00 ± 1.41 days post-admission. Review of these images showed pulmonary opacity in 14 (93.3%; ground-glass opacities in 9 [64.3%], alveolar opacities in 6 [42.9%]), interlobular septal thickening in 10 (66.7%), and pleural effusions in 7 (46.7%). Filling defects were identified in three (20%) CTPAs, with density measuring - 20HU to + 63HU. Ten patients (66.7%) had neuroimaging performed, with two patients demonstrating imaging findings consistent with cerebral fat emboli.
CTPA features of PuFE are variable, with ground-glass parenchymal changes and septal thickening most commonly seen. Filling defects were uncommon.
脂肪栓塞综合征（FES）是创伤患者（通常为长骨骨折）的罕见并发症，其中移行骨髓脂肪沉淀导致多器官功能障碍，经典表现为呼吸困难、瘀点和神经认知功能障碍。尽管这种三联征症状很少见，但它有助于诊断肺脂肪栓塞（PuFE）。虽然在这一组患者中越来越多地使用 CT 肺动脉造影（CTPA），但 PuFE 的典型影像学特征尚未确定。因此，我们在澳大利亚墨尔本的一家 1 级创伤中心对 FES 患者的 CTPA 影像学进行了病例系列研究。
回顾性分析 2006 年至 2018 年期间临床诊断为 FES 的连续患者的病历和各种影像学检查，包括 CTPA，包括人口统计学、损伤及其在住院期间的进展。
纳入了 15 例可检索 CTPA 的 FES 患者（平均年龄 31.2 岁，范围 17-69；12 名男性[80%]）。93.3%有长骨骨折。CTPA 是在入院后 2.00 ± 1.41 天进行的。对这些图像的回顾显示 14 例（93.3%）有肺不透明，其中 9 例（64.3%）为磨玻璃样混浊，6 例（42.9%）为肺泡不透明；10 例（66.7%）有小叶间隔增厚，7 例（46.7%）有胸腔积液。在 3 例（20%）CTPA 中发现了充盈缺损，密度为-20HU 至+63HU。10 例（66.7%）患者进行了神经影像学检查，其中 2 例显示符合脑脂肪栓塞的影像学表现。
PuFE 的 CTPA 特征是可变的，最常见的是磨玻璃状实质改变和间隔增厚。充盈缺损并不常见。
