Chest
Volume 123, Issue 4, April 2003, Pages 1196-1201
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Clinical Investigations in Critical Care
High-Resolution CT Findings in Mild Pulmonary Fat Embolism

https://doi.org/10.1378/chest.123.4.1196Get rights and content

Objective:

The aim of this article is to describe the high-resolution CT (HRCT) findings in mild cases of fat embolism syndrome (FES).

Material and methods:

Nine patients with FES were examined with HRCT of the lungs (collimation, 1 mm/edge-enhancement algorithm). The median age of the patients was 26 years (range, 17 to 35 years). Five cases were included prospectively, and four cases were reviewed retrospectively. Of the major clinical criteria for FES, respiratory signs were present in six patients, CNS signs were present in two patients, and petechiae was present in six patients. HRCT patterns were recorded and analyzed. The type of injury and FES-associated clinical findings were also recorded.

Results:

HRCT findings included ground-glass opacities in seven patients, associated with thickened interlobular septa in five patients and a patchy distribution resulting in a geographic appearance in four patients. A nodular pattern was observed in two patients. Resolution of the abnormalities occurred within 16.4 days (range, 7 to 25 days).

Conclusion:

The HRCT findings of mild fat embolism consist of bilateral ground-glass opacities and thickening of the interlobular septa. Centrilobular nodular opacities are present in some patients.

Section snippets

Materials and Methods

A total of nine patients (eight males and one female; median age, 26 years; range, 17 to 35 years) with documented FES were included in this study. The first five cases were prospectively selected because of the mild severity of imaging findings and indolent clinical course, and the following four cases were retrospectively collected after review of the medical records of patients treated in our hospitals for FES in the last 3 years with the same criteria. No postoperative cases are included in

Results

HRCT demonstrated ground-glass opacities in seven patients (Figure 1, Figure 2) and nodular opacities in two patients (Figure 3, Figure 4). In five patients, the ground-glass opacities were associated with interlobular septal thickening (Figure 1, Figure 2). No airspace consolidation was observed in any of our cases. A peripheral-subpleural, nongravity-dependent distribution was noted in three patients with ground-glass opacities (Fig 2). In four patients, the ground-glass opacities had a

Discussion

Trauma-related fat embolism is defined by the blockage of blood vessels from fat globules that are usually released from traumatic or iatrogenic injury to the long bones.123 The lung is the most frequently affected organ, but reported incidence of pulmonary fat embolism varies considerably between different series; Heitzman9 reported that some degree of pulmonary fat embolism regularly follows long-bone injury. The clinical syndrome, however, is reported to develop between 0.5% and 2% following

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