Diffuse alveolar haemorrhage – Is it an unusual or unlooked presentation of Fat Embolism Syndrome? A Case report and review of literature

Abstract

Fat embolism occurs when fat globules from the bone marrow enter the circulation mostly after orthopaedic trauma causing fractures of long bones, pelvis or vertebra. It also occurs following surgical fixation such as intramedullary nailing, instrumented spine surgery or vertebroplasty.1 Fat embolism syndrome (FES) is a constellation of clinical symptoms characterized by a triad of respiratory insufficiency, altered sensorium and petechiae. Not all patient with fat embolism develops FES. FES generally occurs within 24 hours of onset of trauma or post-surgery.1 The incidence of FES after trauma varies from 0.25% to 35%.1 The diagnosis is based on clinical presentation and excluding other possible conditions. Beside histopathology, none of the investigations such as fat macroglobinuria in urine or lipid laden macrophages in bronchoalveolar lavage (BAL) is 100% specific. Thus, various clinical criteria are available to improve the early diagnosis of FES but none are sensitive or specific. The most widely used clinical criteria is that of Gurd and Wilson which is more specific but less sensitive.2 At times FES can present with atypical presentation such as intra alveolar haemorrhage as in the case described below and only high index of suspicion can help in making diagnosis. Case Report: