Baba Daisuke, Yamashita Yugo, Fukuda Yuki, Yamaji Kyohei, Shiomi Hiroki, Horie Takahiro, Watanabe Shin, Ono Koh
Department of Cardiovascular Medicine, Kyoto University Hospital, Japan.
Intern Med. 2025 Jul 1;64(13):1993-1997. doi: 10.2169/internalmedicine.4472-24. Epub 2024 Dec 26.
A 74-year-old woman presented with sudden dyspnea 22 h after orthopedic surgery. Echocardiography revealed significant right ventricular dilatation, suggesting the development of acute pulmonary embolism. However, contrast computed tomography showed no signs of pulmonary thromboembolism, leading to suspicion of fat embolism syndrome (FES). Despite the administration of high-dose norepinephrine and dobutamine, her hemodynamic status did not improve, and high-dose methylprednisolone (250 mg) was administered. After administration, her hemodynamic status improved promptly, and she soon showed normotension. The current case suggests the possibility of high-dose methylprednisolone for hemodynamic improvement in FES.
一名74岁女性在骨科手术后22小时出现突发呼吸困难。超声心动图显示右心室明显扩张,提示急性肺栓塞的发生。然而,对比计算机断层扫描未显示肺血栓栓塞的迹象,从而怀疑为脂肪栓塞综合征(FES)。尽管给予了大剂量去甲肾上腺素和多巴酚丁胺,但其血流动力学状态并未改善,于是给予了大剂量甲泼尼龙(250mg)。用药后,她的血流动力学状态迅速改善,很快血压恢复正常。本例提示大剂量甲泼尼龙有可能改善FES患者的血流动力学状态。