Morena Donato, Scopetti Matteo, Padovano Martina, Turillazzi Emanuela, Fineschi Vittorio
Department of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, Rome, Italy.
Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy.
Histopathology. 2025 May;86(6):845-861. doi: 10.1111/his.15355. Epub 2024 Oct 31.
Fat embolism (FE) is a historically recognised but still actively researched topic in forensic pathology. Several aspects remain not fully elucidated, such as its aetiopathogenesis, its causal role in death determination, the impact of interfering factors (e.g. cardiopulmonary resuscitation or other medical procedures) and both qualitative and quantitative diagnostic methodologies in clinical and forensic contexts. These issues are further underscored by the potential involvement of FE in the causal determination of non-traumatic deaths, which often raises questions of professional liability. The present study aims to provide a comprehensive and up-to-date overview of the most recent scientific evidence relevant to forensic pathology. Our systematic research has included 58 articles from 1990 to the present on the topic of FE and fat embolism syndrome (FES). From these articles, we identified 45 case reports, from which the authors' descriptions were extracted to provide information on individual cases and the operational methods of forensic pathologists. Additionally, 21 experimental studies were identified, and their key findings have been summarised narratively. It has emerged that both traumatic and non-traumatic cases are frequently reported in the forensic context, with orthopaedic and cosmetic surgery being among the highest-risk specialities. Experimental studies have re-evaluated the role of a patent foramen ovale in the pathogenesis of FE, as well as the impact of cardiopulmonary resuscitation in causing FE severe enough to result in death. Additionally, there are new findings regarding diagnostic techniques, including radiological and immunohistological methods; however, they have not yet fully bridged the reliability gap compared to an accurate autopsy-histological evaluation. The major critical points that emerged include the lack of complete and detailed information on premortem clinical conditions, the underutilisation of grading systems and the methodological heterogeneity applied, resulting in considerable variability regarding the organs studied histologically and the diagnostic techniques used. Despite the limitations associated with the analysis of case reports and the heterogeneity of included experimental studies, we believe that this study can provide a comprehensive overview of the FE topic. It furnishes pathologists with an updated overview useful for clinical practice and guiding future research trends, as well as facilitating the development of standardised procedures.
脂肪栓塞（FE）在法医病理学中是一个历史上已被认识但仍在积极研究的课题。几个方面仍未完全阐明，例如其病因发病机制、在死亡判定中的因果作用、干扰因素（如心肺复苏或其他医疗程序）的影响以及临床和法医背景下的定性和定量诊断方法。FE在非创伤性死亡因果判定中的潜在参与进一步凸显了这些问题，这常常引发职业责任问题。本研究旨在提供与法医病理学相关的最新科学证据的全面和最新概述。我们的系统研究纳入了1990年至今关于FE和脂肪栓塞综合征（FES）主题的58篇文章。从这些文章中，我们识别出45例病例报告，从中提取了作者的描述，以提供关于个别病例以及法医病理学家操作方法的信息。此外，识别出21项实验研究，并对其主要发现进行了叙述性总结。结果表明，在法医背景下，创伤性和非创伤性病例均经常被报道，骨科和整容手术是风险最高的专科领域。实验研究重新评估了卵圆孔未闭在FE发病机制中的作用，以及心肺复苏在导致严重到足以致死的FE方面的影响。此外，在诊断技术方面有新发现，包括放射学和免疫组织学方法；然而，与准确的尸检组织学评估相比，它们尚未完全弥合可靠性差距。出现的主要关键点包括生前临床状况缺乏完整和详细信息、分级系统利用不足以及应用的方法学异质性，导致组织学研究的器官和使用的诊断技术存在相当大的差异。尽管对病例报告的分析存在局限性且纳入的实验研究存在异质性，但我们认为本研究可以提供FE主题的全面概述。它为病理学家提供了一个对临床实践有用的最新概述，指导未来研究趋势，并促进标准化程序的发展。
