RESUMO
INTRODUCTION: fat embolism syndrome (FES) is an acute respiratory disorder that occurs when an inflammatory response causes the embolization of fat and marrow particles into the bloodstream. The exact incidence of FES is not well defined due to the difficulty of diagnosis. FES is mostly associated with isolated long bone trauma, and it is usually misdiagnosed in other trauma cases. The scope of this study was to identify and search the current literature for cases of FES in nonorthopedic trauma patients with the aim of defining the etiology, incidence, and main clinical manifestations. METHODS: we perform a literature search via the PubMed journal to find, summarize, and incorporate reports of fat embolisms in patients presenting with non-orthopedic trauma. RESULTS: the final literature search yielded 23 papers of patients presenting with fat embolism/FES due to non-orthopedic trauma. The presentation and etiology of these fat embolisms is varied and complex, differing from patient to patient. In this review, we highlight the importance of maintaining a clinical suspicion of FES within the trauma and critical care community. CONCLUSION: to help trauma surgeons and clinicians identify FES cases in trauma patients who do not present with long bone fracture, we also present the main clinical signs of FES as well as the possible treatment and prevention options.
Assuntos
Embolia Gordurosa , Ferimentos e Lesões , Embolia Gordurosa/etiologia , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/terapia , Humanos , Ferimentos e Lesões/complicaçõesAssuntos
Encefalopatias/diagnóstico , Embolia Gordurosa/diagnóstico , Lipoabdominoplastia/efeitos adversos , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encefalopatias/complicações , Líquido da Lavagem Broncoalveolar/citologia , Diagnóstico Diferencial , Embolia Gordurosa/complicações , Feminino , Humanos , Pulmão/efeitos dos fármacos , Pulmão/patologia , Transtornos Mentais , Insuficiência Respiratória , Tomografia Computadorizada por Raios XRESUMO
Resumen La liposucción es uno de los procedimientos estéticos que se realizan con mayor frecuencia a nivel mundial, con una baja incidencia de complicaciones y una mortalidad de 20 por cada 100 000 procedimientos y cuando se realiza en conjunto con una lipoinyección glútea la principal causa de muerte el embolismo graso. Se presenta el caso de una femenina de 32 años, sin patologías crónicas conocidas, la cual se asistió a un centro médico para que le realizaran una liposucción con lipoinyección glútea y falleció casi al finalizar la cirugía; en la autopsia Médico Legal se observó la presencia de material de aspecto adiposo en el tronco principal de la arteria pulmonar y en sus ramificaciones, en las cuales se obstruía por completo el lumen, mediante un estudio histopatológico se confirmó el diagnostico de embolismo graso, el cual se estableció como causa de muerte. Se realizó una revisión de la literatura sobre embolismo graso asociado a liposucción con lipoinyección glútea.
Abstract Liposuction is one of the most frequently performed cosmetic procedures worldwide, with a low incidence of complications and a mortality of 20 per 100 000 procedures, and when it is performed in conjunction with gluteal lipoinjection, the main cause of death is fat embolism. This article presents a case of a 32-year-old female, with no known chronic pathologies, who was attended at a medical center to undergo liposuction with gluteal lipoinjection and died almost at the end of the surgery; In the Medico-Legal autopsy, the presence of adipose-like material was observed in the main trunk of the pulmonary artery and in its ramifications, in which the lumen was completely obstructed, a histopathological study confirmed the diagnosis of fat embolism, which was established as the cause of death. A review of the literature about fat embolism associated with liposuction with gluteal lipoinjection was made.
Assuntos
Humanos , Feminino , Adulto , Autopsia , Lipectomia/mortalidade , Embolia Gordurosa/diagnóstico , Costa RicaAssuntos
Anemia Falciforme/complicações , Encéfalo/patologia , Embolia Gordurosa/etiologia , Embolia Intracraniana/etiologia , Adolescente , Anemia Falciforme/diagnóstico , Diagnóstico Diferencial , Embolia Gordurosa/diagnóstico , Feminino , Humanos , Embolia Intracraniana/diagnóstico , Imageamento por Ressonância MagnéticaRESUMO
Gluteal augmentation with fat has become one of the most common cosmetic procedures worldwide. Gluteal augmentation is designed to increase the volume and contour of the gluteal region. Intramuscular lipoinjection has been linked to multiple reports of severe complications, including death due to macro fat embolism (MAFE). The authors present the first reported case of survival and successful recovery after MAFE secondary to gluteal augmentation with fat. A 41-year-old woman, ASA II, was scheduled for augmentation mammaplasty, liposuction, and gluteal augmentation with fat. The patient was operated under general anesthesia with a total intravenous anesthesia technique. A total of 3.5 liters of fat was liposuctioned with no complications. The patient was then positioned in a lateral decubitus position for gluteal augmentation with fat. Right after the last injection, the anesthesiologist noticed a sudden change in capnography followed by hypotension, bradycardia, and hypoxemia. The first reaction in the operating room was to consider that the patient was experiencing a severe episode of fat embolism. She was then resuscitated and transferred to a tertiary facility for intensive care management. To our knowledge, this is the first case report of successful resuscitation in a patient experiencing severe MAFE after gluteal augmentation with fat. We believe that this patient survived the event due to early detection, aggressive management, and proper transfer to an intensive care unit. Level of Evidence: 5.
Assuntos
Contorno Corporal/efeitos adversos , Nádegas/cirurgia , Embolia Gordurosa/terapia , Complicações Intraoperatórias/terapia , Embolia Pulmonar/terapia , Tecido Adiposo/transplante , Adulto , Contorno Corporal/métodos , Capnografia , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/etiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Lipectomia/efeitos adversos , Lipectomia/métodos , Monitorização Intraoperatória , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Ressuscitação/métodos , Transplante Autólogo/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Liposuction and gluteal lipoinjection are two of the most frequent surgical procedures in body contouring surgery, and two of the most important complications are microscopic (MIFE) and macroscopic (MAFE) fat embolism. Despite a high index of morbidity and mortality, few reports exist about these complications, and although they have the same causal agent, their etiopathogenesis, clinical evolution, treatment, prognosis, and prevention are totally different. Therefore, the authors performed a comprehensive review of the literature to exhaustively analyze both pathologic conditions and present the differences between them. METHODS: A detailed search was carried out in PubMed of studies on humans from 1946 to March of 2017 in any language and including the keywords microscopic fat embolism and macroscopic fat embolism with either liposuction or gluteal lipoinjection. The articles found were selected according to the search criteria and were analyzed to provide the final data and recommendations. RESULTS: Of the 1245 and 26 articles that were found on complications related to liposuction and gluteal lipoinjection, respectively, only 41 on liposuction and microscopic fat embolism and seven on gluteal lipoinjection and microscopic fat embolism met the specific criteria for inclusion in the analysis. Only two articles on liposuction and two on gluteal lipoinjection referred to macroscopic fat embolism as a complication. CONCLUSION: Although microscopic fat embolism and macroscopic fat embolism are pathologic conditions with high morbidity and mortality rates in association with liposuction and gluteal lipoinjection, few reports about them exist; therefore, the authors made recommendations based on this study for their diagnosis, prevention, and treatment.
Assuntos
Contorno Corporal/efeitos adversos , Nádegas/cirurgia , Embolia Gordurosa/etiologia , Lipectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Contorno Corporal/métodos , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/patologia , Embolia Gordurosa/terapia , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/terapia , PrognósticoRESUMO
Fat embolism syndrome (FES) is a rare syndrome caused by embolization of fat particles into multiple organs including the brain. It typically manifests with petechial rash, deteriorating mental status, and progressive respiratory insufficiency, usually occurring within 24-48 h of trauma with long-bone fractures or an orthopedic surgery. The diagnosis of FES is based on clinical and imaging findings, but requires exclusion of alternative diagnoses. Although there is no specific treatment for FES, prompt recognition is important because it can avoid unnecessary interventions and clarify prognosis. Patients with severe FES can become critically ill, but even comatose patients with respiratory failure may recover favorably. Prophylactic measures, such as early stabilization of fractures and certain intraoperative techniques, may help decrease the incidence and severity of FES.
Assuntos
Embolia Gordurosa , Embolia Intracraniana , Adulto , Embolia Gordurosa/complicações , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/etiologia , Embolia Gordurosa/terapia , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Masculino , Adulto JovemRESUMO
Embolia gordurosa (EG) é definida como a presença de partículas de gordura na circulação sanguínea as quais têm potencial para gerar fenômenos embólicos e lesão tecidual local, principalmente em pacientes vítimas de traumas e fraturas dos ossos longos. Síndrome de embolia gordurosa (SEG) caracteriza-se pelo surgimento de sinais e sintomas específicos secundários ao acometimento de órgãos-alvo como pulmões, cérebro e pele, na vigência de EGDiscutiremos o caso de uma paciente feminina jovem com síndrome de embolia gordurosa e cor pulmonale agudo 48 horas após acidente de trânsito com fratura do fêmur.
Assuntos
Humanos , Feminino , Adulto Jovem , Diagnóstico Diferencial , Doença Cardiopulmonar/diagnóstico , Doença Cardiopulmonar/fisiopatologia , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/fisiopatologia , Anticoagulantes/uso terapêutico , Coração/fisiopatologia , Fraturas do Fêmur/complicações , Heparina/uso terapêutico , Embolia PulmonarRESUMO
A embolia gordurosa é constituída pela presença de glóbulos de gordura dentro da microcirculação periférica e pulmonar, com ou sem quadro clínico. Há uma fase precoce, representada por uma obstrução mecânica, e uma fase tardia, representada por um fenômeno inflamatório, que se inicia aproximadamente 48 a 72 horas após a obstrução mecânica. O diagnóstico clínico da síndrome de embolia gordurosa pode ser auxiliado pelos critérios de Gurd-Wilson e deve ser suspeitado em doentes com traumatismo e fraturas de ossos longos e deterioração neurológica de forma inexplicada. É necessário no mínimo um critério maior (insuficiência respiratória, sinais neurológicos não relacionados ao traumatismo craniano e manifestações dermatológicas) e quatro menores ou dois maiores. Exames complementares são geralmente inespecíficos. A tomografia de crânio pode estar normal. A ressonância magnética de encéfalo pode mostrar áreas puntiformes que costumam desaparecer em 20 dias, sugerindo que a lesão pode ser predominantemente inflamatória, e não necrótico-isquêmica. Um tratamento específico para a síndrome de embolia gordurosa não existe. Ele consiste no suporte cardiopulmonar e neurológico, além de prevenção e diagnóstico precoce, auxiliando nos cuidados com o doente.
Fat embolism is constituted by the presence of fat globules in the peripheral microcirculation and lung with or without symptoms. There is an early stage, represented by a mechanical obstruction, and a late phase, represented by an inflammatory process, which begins approximately 48-72 hours after the mechanical obstruction. The clinical diagnosis of the syndrome of fat embolism can be aided by the criteria of Gurd-Wilson, and must be suspected in patients with trauma and long bone fractures and unexplained neurological deterioration. It is necessary at least one major criteria (respiratory failure, neurological signs unrelated to head trauma and skin lesions) and four small or two larger ones. Additional tests are usually nonspecific. CT scan may be normal. MRI may show punctate areas that usually disappear in 20 days, suggesting that the inflammatory lesion may be predominantly necrotic and non-ischemic. Specific treatment for fat embolism syndrome does not exist. It is the neurological and cardiopulmonary support, and prevention and early diagnosis, assisting in patient care.