Nixon Mickaela J, Grant Thomas
Medical Sciences Division, University of Oxford, Oxford, UK.
ST4 Anaesthetics, Oxford School of Anaesthesia, Oxford, UK.
J Surg Case Rep. 2021 Oct 26;2021(10):rjab485. doi: 10.1093/jscr/rjab485. eCollection 2021 Oct.
We report the symptom evolution of a young female trauma patient leading to a diagnosis of fat embolism syndrome (FES). Twenty-four hours post-trauma she developed respiratory distress, followed by transient neurological compromise and later petechia. The subtle and fluctuating nature of her presentation made the diagnosis via existing clinical criteria challenging, as did the lack of specificity of thoracic computerized tomography due to the concurrent coronavirus (COVID-19) pandemic. Making the diagnosis was important as it changed the patient's management, likely preventing a diagnosis in extremis. This case emphasizes the importance of maintaining a high clinical suspicion of FES in any (poly)trauma patient. This is especially true during COVID-19, as correctly identifying non-COVID-19 causes of respiratory failure will prevent additional pandemic victims. In addition, this case supports the need for a diagnostic approach that balances clinical, biochemical and imaging features and takes a cumulative approach in order to identify subacute FES.
我们报告了一名年轻女性创伤患者的症状演变过程，最终诊断为脂肪栓塞综合征（FES）。创伤后24小时，她出现呼吸窘迫，随后出现短暂的神经功能障碍，之后出现瘀点。她症状表现的细微和波动性质使得通过现有临床标准进行诊断具有挑战性，同时由于并发冠状病毒病（COVID-19）大流行，胸部计算机断层扫描缺乏特异性也增加了诊断难度。做出诊断很重要，因为这改变了患者的治疗方案，可能避免了在危急情况下才做出诊断。该病例强调了对任何（多发）创伤患者保持高度临床怀疑FES的重要性。在COVID-19大流行期间尤其如此，因为正确识别非COVID-19导致的呼吸衰竭将避免更多的大流行受害者。此外，该病例支持需要一种平衡临床、生化和影像学特征并采取累积方法以识别亚急性FES的诊断方法。
