Velloze Stephanie, Holtrop Melanie, Adams Traci N
University of Texas Southwestern Medical Center, Division of Pulmonary and Critical Care Medicine, United States.
Respir Med Case Rep. 2022 Sep 6;39:101735. doi: 10.1016/j.rmcr.2022.101735. eCollection 2022.
Fat embolism syndrome (FES) is a known complication of long bone fractures, frequently presenting with hypoxemia. Diffuse alveolar hemorrhage (DAH) is a rare complication of the condition. Imaging characteristics are frequently non-specific to FES, as are findings on bronchoalveolar lavage. No specific treatment exists, though steroids and albumin can be considered. We present the case of an 18 year old male who presented to the emergency room after a motorcycle collision. His CXR was initially clear, but he developed pulmonary infiltrates, a new oxygen requirement, and hemoptysis. Bronchoscopy confirmed DAH by serial lavage, and BAL was notable for abundant lipid-laden macrophages by Oil-red-O stain He improved with methylprednisolone and albumin. This case highlights the need for a high index of suspicion both for FES, and for DAH as a complication that may develop days after trauma. We review treatment paradigm for this serious condition.
脂肪栓塞综合征（FES）是长骨骨折已知的并发症，常表现为低氧血症。弥漫性肺泡出血（DAH）是该病症的一种罕见并发症。影像学特征对于FES而言通常不具有特异性，支气管肺泡灌洗的结果也是如此。虽然可以考虑使用类固醇和白蛋白，但目前尚无特异性治疗方法。我们报告一例18岁男性病例，该患者在摩托车碰撞后被送往急诊室。他最初的胸部X线检查结果清晰，但随后出现了肺部浸润、新的吸氧需求和咯血。支气管镜检查通过连续灌洗确诊为DAH，支气管肺泡灌洗显示油红O染色可见大量含脂巨噬细胞。他使用甲泼尼龙和白蛋白后病情好转。该病例强调了对于FES以及作为创伤后数天可能发生的并发症的DAH都需要高度怀疑。我们回顾了这种严重病症的治疗模式。
