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OBJECTIVES:
Fat Embolism Syndrome (FES), associated with up to 20% of long bone and pelvic fractures, is a disease process that can be potentially fatal. FES is often confused with deep venous thrombosis (DVT), and there are no commonly accepted diagnostic criteria to assist with diagnosis. As the management of these two diseases is markedly different, early and accurate diagnosis can help guide proper management in these patients.
METHODS:
We identified two patients with FES who underwent bilateral lower extremity venous duplex studies after sustaining long bone fractures. We were able to document sonographic evidence of fat emboli in two patients and use them to generate diagnostic criteria that distinguish them from DVT.
RESULTS:
The first patient was an 83-year-old female with an open distal femur fracture sustained after a fall. Due to concerns for a possible pulmonary embolism after the onset of pleuritic chest pain, a lower extremity venous duplex study was obtained. A second patient was an 18-year-old male thrown from a vehicle who sustained bilateral femur fractures. A venous duplex ultrasound was completed due to concerns for a DVT. In both patients, no DVT was identified, but a discrete, free floating, and embologenic lesion was identified on ultrasound. Sub-centimeter radio-opaque, spherical lesions were identified passing through the deep veins. There were no findings consistent with venous augmentation, respiratory variation, compressibility or flow limitations.
CONCLUSIONS:
Fat emboli are distinguished from DVT by their radio-opaque, spherical nature. They are not attached to the venous wall and are not compressible. As a result, standard signs associated with a DVT are not found with FES. Patients with ultrasonographic evidence of FES who develop subsequent PE should not be heparinized.