Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
Chest. 2023 Mar;163(3):e107-e110. doi: 10.1016/j.chest.2022.10.018.
Fat embolism syndrome describes a constellation of symptoms that follow an insult and that results in a triad of respiratory distress, neurologic symptoms, and petechia. The antecedent insult usually entails trauma or orthopedic procedure, most frequently involving long bone (especially the femur) and pelvic fractures. The underlying mechanism of injury remains unknown but entails biphasic vascular injury with vascular obstruction from fat emboli followed by an inflammatory response. We present an unusual case of a pediatric patient with acute onset of altered mental status, respiratory distress, hypoxemia, and subsequent retinal vascular occlusions after knee arthroscopy and lysis of adhesions. Diagnostic findings most supportive of the fat embolism syndrome included anemia, thrombocytopenia, pulmonary parenchymal, and cerebral pathologic findings on imaging studies. This case highlights the importance of fat embolism syndrome as a diagnostic consideration after an orthopedic procedure, even absent major trauma or long bone fracture.
脂肪栓塞综合征描述了一系列在损伤后出现的症状，并导致三联征，即呼吸窘迫、神经症状和瘀点。先前的损伤通常涉及创伤或矫形手术，最常见的是长骨（特别是股骨）和骨盆骨折。损伤的潜在机制尚不清楚，但涉及双相血管损伤，脂肪栓塞导致血管阻塞，随后发生炎症反应。我们报告了一例儿科患者的不寻常病例，该患者在膝关节镜检查和粘连松解后，出现急性精神状态改变、呼吸窘迫、低氧血症和随后的视网膜血管闭塞。最支持脂肪栓塞综合征的诊断发现包括贫血、血小板减少、肺部实质和脑部影像学研究的病理发现。该病例强调了脂肪栓塞综合征作为矫形手术后的一个诊断考虑因素的重要性，即使没有重大创伤或长骨骨折。
