MASSIVE CEREBRAL FAT EMBOLISM AFTER A HIP FRACTURE WITHOUT EVIDENCE FOR RIGHT-TO-LEFT SHUNT

Cerebral fat embolism without right-to-left shunt

Abstract

Introduction: Cerebral fat embolism (CFE) syndrome is a rare complication of long-bone fractures with characteristic neuroimaging findings.

Case Report: An 83-year-old woman underwent total hip replacement surgery after suffering a hip fracture due to a fall. Soon after extubation, the patient acutely developed shortness of breath and eventually fell into a coma. A petechial rash was noted on her skin. Brain-MRI showed numerous, scattered, hyperintense, small-sized, embolic lesions on Diffusion-Weighed-Imaging sequences, and hypointense lesions located in the splenium of the corpus callosum and the cerebellum on Gradient-Echo sequences. Transesophageal echocardiography did not reveal patent foramen ovale or other interatrial communication. Based on the abrupt onset, simultaneous involvement of the skin, brain and respiratory system, fat embolism syndrome was diagnosed.  

Conclusion: Massive CFE is a rare and potentially devastating complication following acute trauma, which may develop even after a minor trauma and without the presence of a right-to-left shunt.