Fat embolism may be responsible for hypoxemia in trauma patients with no radiological pulmonary abnormalities

Fat embolism syndrome (FES) is an infrequent consequence (1% in retrospective reviews) of the release of fat droplets into systemic circulation, an event that may follow trauma and other disparate medical and surgical conditions.1–3 By far, the most common inciting condition is fracture of long bones, with incidence increasing with the number of fractures.1,2 The diagnosis is essentially clinical, as it is based on the occurrence, usually within 12 to 48 hours after the triggering circumstance, of a variable combination of respiratory manifestations, neurologic symptoms, and petechial rash.1,2,4 No laboratory test is diagnostic of the syndrome, but adjunctive investigations (i.e. cytological examination of bronchoalveolar lavage, BAL) may be useful to strengthen the clinical suspect in patients with few, nonspecific symptoms.1,2,5–7 In the case herein reported, a high percentage of fat-laden macrophages in BAL helped us make a diagnosis of FES in a trauma patient who had hypoxemia as the sole clinical manifestation, and did not have radiologic pulmonary abnormalities (chest roentgenogram and computed tomography [CT] scan).