Fat Embolism and Fat Embolism Syndrome

Q: What is the difference between fat embolism (FE) and fat embolism syndrome (FES)?


Answer: FE and FES are technically two related but different entities. FE is the presence of fat globules in the pulmonary circulation. In contrast, fat embolism syndrome (FES) is pulmonary and systemic symptoms due to the release of the fat particle into the circulation. Pathophysiology of FE is mostly mechanical and occurs within hours of the insult. FES is probably an extension or complication of FE and is more biochemical in nature. It may occur as a late manifestation of FE up to three days, can be more fatal, hard to manage and it is due to the release of free fatty acid, cytokines C-reactive protein in the blood.

#pulmonary
#ortho
#trauma
#shock



References: 

1. Stein PD, Yaekoub AY, Matta F, Kleerekoper M. Fat embolism syndrome. Am J Med Sci 2008; 336:472. 

2. Mellor A, Soni N. Fat embolism. Anaesthesia 2001; 56:145.

3. Nixon JR, Brock-Utne JG. Free fatty acid and arterial oxygen changes following major injury: a correlation between hypoxemia and increased free fatty acid levels. J Trauma 1978; 18:23. 

4.  Kao SJ, Yeh DY, Chen HI. Clinical and pathological features of fat embolism with acute respiratory distress syndrome. Clin Sci (Lond) 2007; 113:279. 

5. Prakash S, Sen RK, Tripathy SK, et al. Role of interleukin-6 as an early marker of fat embolism syndrome: a clinical study. Clin Orthop Relat Res 2013; 471:2340.