Symptoms
Typical symptoms of fat embolism include The first symptom is typically difficult breathing and may even be shortness of breath. In addition, small skin bleedings (petechiae) occur in typical body regions, such as the head, conjunctiva, chest and armpit. The embolic occlusion of brain vessels can lead to neurological symptoms.
These are mainly focal sensory disturbances and paralysis, reduced alertness and confusion. Other symptoms include increased heart rate and fever. This can be accompanied by anemia, a lack of platelets (thrombocytopenia) and a high blood sedimentation rate (BSG).
These are signs of an inflammatory process. In addition, kidney failure with reduced urine production or changes in the ocular fundus are possible.
- Respiratory Insufficiency
- Petechiae
- Neurological symptoms and failures
- Fever
- Heart rate increase
- When abdominal pain and back pain occur together
- Acute respiratory failure
Diagnosis
The fat embolism shows a striking clinical appearance, which should prompt the attending physician to suspect pulmonary embolism. Clinically, pathological vital signs are conspicuous. The combination of a drop in blood pressure, an increase in heart rate and shortness of breath with a resulting increase in respiratory rate are typical of pulmonary embolism.
The increase in pressure in the pulmonary vessels can lead to a strain on the right heart. This is shown, for example, by a so-called upper influence congestion (congestion of the neck veins). A split 2nd heart tone can also be noticeable.
This is caused by a delayed closing of the pulmonary valve. Venous blood should be taken from the patient and a blood gas analysis performed. Typically, reduced partial pressures of oxygen (pO2) and carbon dioxide (pCO2) are noticeable.
This is usually followed by the imaging confirmation of the suspected diagnosis. For this purpose, CT or MR angiography and, if necessary, echocardiography or perfusion and ventilation scintigraphy are used. In CT angiography, the pulmonary arteries can be visualized with the aid of a contrast medium.
This method has a high sensitivity in detecting pulmonary artery occlusions. Possible radiological signs include the occurrence of atelectasis (airless areas caused by the collapse of the pulmonary alveoli) and pleural effusions. Also typical are the Westermark sign (prominent central pulmonary arteries with a conspicuous jump in caliber in the periphery), Hampton ́s hump with a wedge-shaped reduction in transparency in the lung periphery, as a sign of a pulmonary infarction, and dilatation (enlargement) of the right heart. When performing a perfusion and ventilation scintigraphy, an imbalance of these two parameters is typically observed. While ventilation (supply to the lungs via the airways) is usually still fully maintained, the embolus causes limited perfusion (blood supply to the lungs).
