Xu L et al. 20232222 Xu L, Tan X, Chen X, Du S, Yue X, Qiao D. Rare, fatal pulmonary fat embolism after acupuncture therapy: A case report and literature review. Forensic Sci Int. 2023;345:111619. doi: 10.1016/j.forsciint.2023.111619. https://doi.org/10.1016/j.forsciint.2023...
|
Soft tissue injury due to silver-needle acupuncture therapy |
-Dizziness/ fatigue -Anormal mental status -Significant Hypotension |
-ECG: ST-T changes -CT: widening of inf pulmonary artery and RA, LV, RV |
Autopsy |
N/A |
Death |
Pham 20222323 Pham MQ. Fat Embolism After Plastic Surgery: A Case Report. Plast Aesthetic Nurs. 2022;42:27-30. doi: 10.1097/PSN.0000000000000414. https://doi.org/10.1097/PSN.000000000000...
|
Plastic surgery (breast surgery and abdominal liposuction) |
-mild dyspnea -decreased O2 saturation -chest tightness/fatigue |
- CT: fat embolus in right pulmonary artery |
Chest CT |
Anticoagulants |
Patient discharged postoperative day 7 |
Wolfe et al. 20222424 Wolfe EM, Weber LE, Wo LM, Samaha MJ, Mathew P, Garcia O, et al. Two Cases Surviving Macro Fat Emboli Complications Following Gluteal Fat Grafting. Aesthet Surg J. 2022;42:902-6. doi: 10.1093/asj/sjac063. https://doi.org/10.1093/asj/sjac063...
|
Case 1: BBL surgery (Brazilian Butt Lift) |
Case 1: -Hypotension -Tachycardia -Cyanosis -Hypoxia -Severe respiratory acidosis |
Case 1: -CT: multiple pulmonary emboli with diffuse ground-glass opacities |
Case 1: Chest CT |
Case 1: Norepinephrine (NE) infusion and 100% fraction of 02. Required 6 days of ECMO. |
Patient discharged Postoperative day 24 with tunneled hemodialysis catheter and was listed for renal transplantation due to kidney failure. |
|
Case 2: Liposuction with fat transfer |
Case 2: -Respiratory distress -Hypoxia -Severe respiratory acidosis |
CCase 2: -CT: pulmonary emboli and splenic and renal micro emboli -Brain CT: hypodensity of right middle cerebral artery |
Case 2: Chest CT |
Case 2: Intubation |
Patient discharged after 10 days of physical therapy. Patient returned due to post-operative complications after 1 month. |
Case |
Underlying Cause |
Main Clinical Presentation |
Main Radiological Findings |
Diagnostic Tool |
Treatment |
Outcome |
Kadar et al. 20212525 Kadar A, Shah VS, Mendoza DP, Lai PS, Aghajan Y, Piazza G, et al. Case 39-2021: A 26-Year-Old Woman with Respiratory Failure and Altered Mental Status. N Engl J Med. 2021;385:2464-74. doi: 10.1056/NEJMcpc2107355. https://doi.org/10.1056/NEJMcpc2107355....
|
Elective Liposuction |
-Respiratory failure -Altered mental status -Tachycardia -Low O2 saturation |
-ECG: right axis deviation and ST-T changes -CT: bilateral diffuse ground-glass lung opacities -Brain CT: diffuse edema and infarction |
Bronchoa veolar lavage (BAL) |
Positive airway pressure, antibiotics, intubation, and mechanical ventilation |
Patient transferred from ICU to general medicine unit on hospital day 7 with moderate cognitive impairment which improved after 1 month follow-up. |
Dong et al. 20212626 Dong W, Wan D-Y, Yang X, Fu M, Liu X, Li H, et al. Delayed onset of fat embolus in the cerebral venous system after breast and hip augmentation: a case report. BMC Neurol. 2021;21:411. doi: 10.1186/s12883-021-02419-x. https://doi.org/10.1186/s12883-021-02419...
|
Trauma craniotomy after breast and hip augmentation |
-disturbance of consciousness -convulsion of right upper extremity -intracranial hypertension |
no chest CT or echocardiogram abnormalities |
Fat embolus found during trauma craniotomy |
Transfer to neuro ICU after surgery. |
Patient discharged on hospital day 30 with regained cognitive function. |
Dhooghe et al. 20222727 Dhooghe NS, Maes S, Depypere B, Claes KEY, Coopman R, Kubat B, et al. Fat Embolism After Autologous Facial Fat Grafting. Aesthet Surg J. 2022;42:231-8. doi: 10.1093/asj/sjab252. https://doi.org/10.1093/asj/sjab252...
|
Facial fat graft |
N/A |
N/A |
Autopsy |
N/A |
Death |
Uz et al. 20202828 Uz I, Yalçinli S, Efe M. Fat embolism syndrome after gluteal augmentation with hyaluronic acid: A case report. Ulus Travma Acil Cerrahi Derg. 2020;26(6):960-2. doi:10.14744/tjtes.2019.08433. https://doi.org/10.14744/tjtes.2019.0843...
|
Buttock Hyaluronic acid filler injection |
-agitation/altered mental status -low O2 saturation -decreased respiratory sounds |
Chest CT: bilateral ground-glass opacities and pleural effusion |
Brain CT: multiple millimetric hypertense foci |
Enoxaparin and methylprednisolone |
Discharged after 20 days in the hospital |
Wang et al. 20202929 Wang C, Wang X, Huang J, Yu N, Long X. Severe fat embolism after autologous fat grafting in vaginal tightening and breast augmentation surgery. J Int Med Res. 2020;48:300060520949109. doi: 10.1177/0300060520949109. https://doi.org/10.1177/0300060520949109...
|
Liposuction and fat injection |
-hypoxemia -tachycardia -respiratory acidosis |
Chest CT: multiple filling defects bilaterally and patchy shadows |
CT findings |
Anticoagulants and steroids, oxygen therapy |
Patient discharged after 18 days in the hospital. |
Meng et al. 20203030 Meng Y, Zhang M, Ling H, Huang S, Miao Q, Yu Y, et al. Nontraumatic Multiple-Organ Fat Embolism: An Autopsy Case and Review of Literature. Am J Forensic Med Pathol. 2020;41:131-4. doi: 10.1097/PAF.0000000000000544. https://doi.org/10.1097/PAF.000000000000...
|
Hit by a car (no fracture) |
-unconsciousness |
N/A |
Autopsy |
N/A |
Death |
Lee et al. 20203131 Lee HS, Park J-J, Roh HG, Lim SD. Unusual clinicopathological presentation of nontraumatic cerebral fat embolism: Two-case report. Medicine (Baltimore). 2020;99:e19574. doi: 10.1097/MD.0000000000019574. https://doi.org/10.1097/MD.0000000000019...
|
Autologous fat grafting |
-hemiparesis -hemisensory deficits |
MRA: acute occlusion of right middle cerebral artery |
Microscopic findings of aspirated material |
Aspirational thrombectomy |
Patient discharged after 5 days in hospital. Recovered neurological deficits after 1 year. |
Case |
Underlying Cause |
Main Clinical Presentation |
Main Radiological Findings |
Diagnostic Tool |
Treatment |
Outcome |
Lu 20193232 Lu Y-Q. Young Woman With Seizures. Ann Emerg Med. 2019;74:305-9. doi: 10.1016/j.annemergmed.2019.02.016. https://doi.org/10.1016/j.annemergmed.20...
|
Autologous fat graft |
-seizures and collapse |
Ultrasonography: solid echogenic material in carotid |
Digital subtraction angiography revealed fat particles. |
N/A |
Patient died after 20 days of diagnosis due to massive bilateral cerebral infarction |
Peña et al. 20193333 Peña W, Cárdenas-Camarena L, Bayter-Marin JE, McCormick M, Durán H, Ramos-Gallardo G, et al. Macro Fat Embolism After Gluteal Augmentation With Fat: First Survival Case Report. Aesthet Surg J. 2019;39:NP380-NP383. doi: 10.1093/asj/sjz151. https://doi.org/10.1093/asj/sjz151...
|
Liposuction and fat injection |
-low O2 saturation -hypotension |
-Echo: RV dysfunction -Chest CT: ground glass opacities |
Chest CT |
Intubation and tracheostomy |
Patient stayed in ICU for 80 days with Acute Respiratory Distress Syndrome (ARDS). At discharge, neurological function was normal but intensive |
Rosenfeld et al. 20193434 Rosenfeld DM, Smith ML, Seamans DP, Giorgakis E, Gaitan BD, Khurmi N, et al. Fatal diffuse pulmonary fat microemboli following reperfusion in liver transplantation with the use of marginal steatotic allografts. Am J Transplant. 2019;19:2640-5. doi: 10.1111/ajt.15399. https://doi.org/10.1111/ajt.15399...
|
2 cases: Transplantation using marginal steatotic liver grafts. |
-low oxygenation postsurgery - Pulseless Electrical Activity (PEA) |
-Chest X ray: diffuse airspace/perihilar opacities |
Autopsy |
N/A |
Death |
Zhibin et al. 20183535 Zhibin Z, Peng S, Fang C. Fat embolism following a liposuction procedure. Neurol India. 2018;66:1206-7. doi: 10.4103/0028-3886.236965. https://doi.org/10.4103/0028-3886.236965...
|
Liposuction |
-Deterioration of consciousness -Left hemialgia -Petechiae after 14 hr |
-MRI: large areas of hyperintense foci -Brain CT: low intensity signal in left hemisphere -Chest CT: normal |
Clinical presentation and CT/MRI findings |
N/A |
Patient died after her condition deteriorated due to hepatic failure, acute renal insufficiency, pneumonia, and cerebral herniation. |
Scarpino et al. 20183636 Scarpino M, Lanzo G, Moretti M, Olivo G, Amantini A, Grippo A. Delayed cerebral fat embolism occurring after off-pump coronary artery bypass grafting. Cardiol J. 2018;25: 155-7. doi: 10.5603/CJ.2018.0015. https://doi.org/10.5603/CJ.2018.0015...
|
Off-pump CABG |
-chest pain -Dyspnea |
Brain CT: presence of hypodense lesions with the range of fat |
MRI: hyperintense lesions in same areas as CT |
N/A |
Patient transferred to ICU with major neurological deficits. No further information was given. |
Ali et al. 20173737 Ali A, Theobald G, Arshad MA. Fat attacks! a case of fat embolisation syndrome postliposuction. BMJ Case Rep. 2017;2017:bcr2017220789. doi: 10.1136/bcr-2017-220789. https://doi.org/10.1136/bcr-2017-220789...
|
Liposuction |
Triad of: -respiratory failure -cerebral dysfunction -petechial rash |
Chest X-ray: bilateral generalized nfiltrates |
Clinical presentation and history |
Atropine, intubation, and organ support |
Patient discharged 14 days after extubation with good recovery. |
Cantu and Pavlisko 20173838 Cantu CA, Pavlisko EN. Liposuction-induced fat embolism syndrome. BMJ Case Rep. 2017;2017:bcr2017219835. doi: 10.1136/bcr-2017-219835. https://doi.org/10.1136/bcr-2017-219835...
|
Liposuction |
-Dyspnea -Amaurosis -Hypoxemia |
Chest CT was contraindicated |
Autopsy |
N/A |
Death |
Case |
Underlying Cause |
Main Clinical Presentation |
Main Radiological Findings |
Diagnostic Tool |
Treatment |
Outcome |
Sato et al. 20163939 Sato HK, Kowacs PA, Dalmau J, Santos PSF. Fat embolism showing restriction on diffusion sequence in brain magnetic resonance imaging. Arq Neuropsiquiatr. 2016;74:597-8. doi: 10.1590/0004-282X20160052. https://doi.org/10.1590/0004-282X2016005...
|
Liposuction and abdominoplasty |
-Fever -Dyspnea -Bilateral papilledema |
MRI: restriction in diffusion |
Surgical history |
Anticoagulant |
Amaurosis was not reversed with anticoagulants. |
Mendoza-Morales et al. 20164040 Mendoza-Morales RC, Camberos-Nava EV, Luna-Rosas A, Garcés-Ramírez L, De la Cruz F, García-Dolores F. A fatal case of systemic fat embolism resulting from gluteal injections of vitamin e for cosmetic enhancement. Forensic Sci Int. 2016;259:e1-4. doi: 10.1016/j.forsciint.2015.11.012. https://doi.org/10.1016/j.forsciint.2015...
|
Injection of Vitamin E |
-Respiratory distress -Acute Renal Failure -Neurological impairment |
Tomography: cerebraledema |
Autopsy |
N/A |
Death |
Jacob et al. 20164141 Jacob S, Courtwright A, El-Chemaly S, Racila E, Divo M, Burkett P, et al. Donor-acquired fat embolism syndrome after lung transplantation. Eur J Cardio-Thorac Surg. 2016;49:1344-7. doi: 10.1093/ejcts/ezv347. https://doi.org/10.1093/ejcts/ezv347...
|
2 cases due Donor-acquired FE after lung transplantation |
Case 1: Hypoxemic respiratory failure |
Case 1: Chest CT: consolidation in donor lung |
Case1: Histological evaluation of the donor lung |
Case 1: Ventilation and tracheostomy |
Discharged after prolonged respiratory failure to a acute rehabilitation facility. |
Case 2: Severe hypoxemia and frothy secretions |
Case 2: Chest CT: patchy opacities |
Case2: CT and intraoperative findings |
Case 2: ECMO |
Discharged after prolonged respiratory failure to an acute rehabilitation facility. However, patient died due to transplant rejection. |
Berger et al. 20134242 Berger N, Paula P, Gascho D, Flach PM, Thali MJ, Ross SG, et al. Bone marrow edema induced by a bullet after a self-inflicted accidental firing. Leg Med (Tokyo). 2013;15:329-31. doi: 10.1016/j.legalmed.2013.09.002. https://doi.org/10.1016/j.legalmed.2013....
|
Gunshot Wounds with no fracture |
N/A |
N/A |
Autopsy |
N/A |
Death |
Bajraktari et al. 20224343 Bajraktari M, Naco M, Huti G, Arapi B, Domi R. Fat Embolism Syndrome Without Bone Fracture: Is It Possible? Open Access Maced J Med Sci. 2022;10:331-5. doi: 10.3889/oamjms.2022.11169. https://doi.org/10.3889/oamjms.2022.1116...
|
Minimal Soft Tissue Trauma Due to a Motor Vehicle Collision with no fractures |
-Hypoxemia -Petechia -Conjunctival pallor -Confusion |
-Chest X-ray : diffuse infiltrates -Chest CT: significant consolidations |
Bronchoalveolar lavage (BAL) |
-Mechanical ventilation -Supportive care |
Patient discharged after 15 days in the hospital. |
Fowler et al. 20214444 Fowler JB, Fiani B, Sarhadi K, Cortez V. Cerebral fat embolism in the absence of a long bone fracture: A rare case report. Surg Neurol Int. 2021;12:78. doi: 10.25259/SNI_946_2020. https://doi.org/10.25259/SNI_946_2020...
|
Motor Vehicle accident with no fractures |
-Left facial droop -Left upper extremity drift |
-Brain CT: Hyperdense MCA |
Pathological analysis of suctioned thrombus |
Monitoring in ICU |
Patient discharged with outpatient physical therapy. |