LIPOIDI EMBOLISM

(Vascular embolism from fat cells)

HISTORY-GENERAL

The fat embolism was first mentioned in literature in 1862 by ZENKER after autopsy.

Initial clinical diagnosis of fat embolism described in 1873 by von Bergmann.

This is a clinical syndrome that typically occurs between the first and third 24 hours after bone fractures or orthopedic surgery. The mainly affected organs other than lungs is the brain and skin.

Pathophysiology

There are 2 theories about the pathogenesis of the "fat embolism"

1st case

Fat droplets released into the venous system and invade small blood vessels causing

1. local ischemia

2. inflammation

through:

• release of inflammatory mediators

• platelet aggregation

• production vessel-amine a tackle

2nd Case

Hormonal changes caused by

• Trauma and / or

• Septic situation

Result in the production and release of free fatty acids (eg, chylomicrons)

IMPACT

No data on the incidence of fat embolism and is due to following reasons:

1. Subclinical forward (manifestion)

2. There are no laboratory tests that will reliably make the diagnosis

CAUSES LIPOIDOUS EMBOLISM

Especially in situations involving the orthopedic:

* Fractures of long bones (especially closed fractures) 90%
* Orthopedic surgery (eg surgical repair of joints)

But other medical conditions are predisposing factors for the occurrence of the syndrome, such as:

* Acute pancreatitis
* Sickle crisis
* Diabetes mellitus
* Burns
* Laser
* Coronary artery bypass
* Parenteral nutrition with lipid

Clinical picture

As mentioned most often diadramei ypoklinikos.

If this does not happen, the clinical picture varies:

* The seriousness and
* The system is infected

Usually the first events is the respiratory system, where the symptoms most often are severe (intense dyspnea-tachypnea-hypoxia and / or anapnesytiki failure. Approximately 50% of patients requiring mechanical ventilation. This situation requires diversification-diagnostic exclusion:

* Pulmonary embolism and
* Respiratory distress syndrome (ARDS).

The symptoms of other systems (brain, skin), usually post-respiratory symptoms.

The infection of the brain occurs mainly with disorders of consciousness, tremor, focal neurological symptoms. Finally may occur primarily skin rash over the trunk of the body and particularly in the areas of the head, neck, anterior chest wall, the axillary countries.

MORTALITY

10-20% of patients will come. Such conditions are mainly age and coexistence of other diseases.

DIAGNOSIS

A LUNG

Radiography, Computed Tomography, Computed tomography angiography of no help in diagnosing the syndrome

Recently proposed

1. HRCT (high resolution computed tomography thorax) which highlights alveolar type amfo shadows in pulmonary parenchyma 'way of blurred glass ", as well as fattening perivronchiki

2. BAL (bronchoalveolar lavage) which found fat droplets in alveolar macrophages

B. BRAIN

The simple brain CT scan is usually normal. Nevertheless, the brain magnetic resonance imaging (MRI) is a more sensitive method.

So dominant role in the diagnosis of fat embolism are

* The recent history of the patient and
* The symptomatology.

The classic triad:

1. hypoxia

2. neurological disorders

3. skin rash

should give serious suspicion of the syndrome

THERAPY

The fat embolism is a syndrome that may endanger the patient. The problem is complex and requires the help of several Specialty: Pulmonology, orthopedic, neurologist / neurosurgeon, Intensivist, hematology, nutritionist.

* Treatment should address the hypoxia and / or respiratory failure with high oxygen and / or mechanical ventilation.
* Hydration
* Prophylaxis of deep vein thrombosis
* In cases of fracture should be treated immediately to prevent further release of fat droplets in blood.
* In some cases it is useful to cortisone administration