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Signs and Symptoms of Chest Diseases |

Fat Embolism Syndrome Presenting as Diffuse Alveolar Hemorrhage

Ammar Alkhazna*, MD; Ashraf Gohar, MD; Anwaar Saeed, MD; Hassan Taha, MD
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University of Missouri-Kansas City (UMKC), Kansas City, MO


Chest. 2012;142(4_MeetingAbstracts):973A. doi:10.1378/chest.1387154
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Abstract

SESSION TYPE: Miscellaneous Case Report Posters I

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Fat Embolism Syndrome (FES) is potentially catastrophic condition. The presentation of FES can be nonspecific. Rare presentations were reported in the literature. We are presenting a rare case of FES presenting as Diffuse Alveolar Hemorrhage (DAH) in a patient who had a traumatic tibial fracture.

CASE PRESENTATION: A 20 year old male who sustained multiple gunshot wounds presented with open fractures of right ankle and malleoli. He underwent open reduction with internal fixation. On the second postoperative day, he developed dry cough and a low-grade fever and mild hypoxia. CT angiogram was negative for pulmonary embolism, but showed interstitial and alveolar edema. Bronchoscopic Bronchoalveolar Lavage (BAL) revealed diffuse alveolar hemorrhage in the upper lobes. Evaluation for different etiologies of alveolar hemorrhage was negative otherwise. Hypoxia gradually resolved on nonspecific supportive therapy and he was discharged on room air on the 7th day of hospitalization.

DISCUSSION: FES has an extremely heterogeneous pattern of presentation and the diagnosis continues to be elusive. In up to one-third of patients with DAH, hemoptysis is absent and the diagnosis is established when sequential BAL reveals worsening RBC counts. DAH is a very rare presentation of FES. We conducted a systemic literature search of PubMed and Medline on Ovid databases. We found 4 case reports of alveolar hemorrhage in patients with FES (3 were French papers and one in English). All cases are compared in Table 1. Like other cases described in the literature, our patient was of young age and was hypoxic. Our patient’s hypoxia resolved within 7 days. In our case, DAH was diagnosed based on serial hemorrhagic BALs. The exact incidence of FES is unknown, and may be much higher than reported in retrospective studies. All reported cases of DAH in FES were not fatal. This raises questions if the DAH in FES is under diagnosed. Four of the five patients with DAH and FES were due to traumatic fractures. This is consistent with previous studies that showed trauma is the most common cause of FES.

CONCLUSIONS: FES usually presents as a multisystem disorder with nonspecific signs and symptoms. Physicians should have a high index of suspicion for FES in trauma patients who develop hypoxia especially if alveolar hemorrhage is present.

1) Froidure M, et al. [Fat embolism with lung hemorrhage]. Rev Mal Respir. 2001 Dec;18(6 Pt1):657-60. Review. French.

DISCLOSURE: The following authors have nothing to disclose: Ammar Alkhazna, Ashraf Gohar, Anwaar Saeed, Hassan Taha

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University of Missouri-Kansas City (UMKC), Kansas City, MO

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