Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical.
University, Kaohsiung, Taiwan.
Medicine (Baltimore). 2022 Jun 17;101(24):e29331. doi: 10.1097/MD.0000000000029331.
Fat embolism syndrome (FES) is composed of a triad of symptoms, including respiratory distress, neurologic deficit, and petechiae. Respiratory distress usually presents first before the other symptoms. Thrombotic pulmonary embolism (TPE) is a differential diagnosis of FES. Trauma is a risk factor for both diseases; however, co-occurrence is rare.
A 35-year-old male patient presented with altered consciousness, focal neurologic deficit, and respiratory distress after a left femoral subtrochanteric fracture and subsequent open reduction and internal fixation with an intramedullary nail.
Computed tomography pulmonary angiography (CTPA) revealed lower pulmonary artery filling defects and ground-glass opacities in bilateral lung, indicating TPE and FES, respectively.
Heparin was initially added and subsequently switched to apixaban. The symptoms improved quickly without major bleeding complications.
Concomitant TPE and FES after trauma are rare and require different treatment approaches. Due to clinical similarities, prompt chest CTPA was advised to detect TPE that was treated with anticoagulant therapy instead of supportive care for FES.
脂肪栓塞综合征（FES）由三联征组成，包括呼吸窘迫、神经功能缺损和瘀点。呼吸窘迫通常在其他症状之前首先出现。血栓性肺栓塞（TPE）是 FES 的鉴别诊断之一。创伤是这两种疾病的危险因素；然而，同时发生的情况很少见。
一名 35 岁男性患者因左股骨转子下骨折，随后行髓内钉内固定术发生开放性复位，出现意识改变、局灶性神经功能缺损和呼吸窘迫。
计算机断层肺动脉造影（CTPA）显示双侧肺下部肺动脉充盈缺损和磨玻璃影，分别提示 TPE 和 FES。
最初加用肝素，随后改用阿哌沙班。症状迅速改善，无重大出血并发症。
创伤后同时发生 TPE 和 FES 很少见，需要不同的治疗方法。由于临床表现相似，建议进行快速胸部 CTPA 以检测 TPE，TPE 采用抗凝治疗，而 FES 则采用支持性治疗。
