Fulminant pulmonary fat embolism – undetected silent killer

Background

Fulminant pulmonary fat embolism (PFE) is the most severe form of fat embolism. The aim of the study was to assess the presence/severity of PFE in individuals following major blunt trauma with no plausible cause of death identified at autopsy.

Methods

This was a prospective cohort study conducted at the University Hospital Ostrava, Czech Republic. During the study period, all persons who died after major trauma and were brought to the Department of Forensic Medicine were assessed for the study eligibility.

Results

A total of 134 deaths were due to major blunt trauma (road traffic accident victims, crime victims, suicide victims). Of these, the autopsy didn't reveal an obvious gross traumatic cause of death in 19 people who were included in the study. The mechanisms of trauma included falls (6 cases) and road traffic accidents (13 cases).

Severe injuries were found in 57.8 % of cases and multiple severe injuries in 36.8 % of cases. However, none of these serious injuries were considered fatal/lethal. Heart failure and brain swelling were the most common causes of death in the study group; fulminant PFE was the main cause of death in 4 (21.1 %) of cases.

Microscopic examination of lung cryosections revealed PFE grade I – III in all study cases. That's why the pathologists pronounced PFE as an important factor contributing to the onset of death in all study cases. In addition, massive PFE (grade III) was identified as the main cause of death in 21.1 % of cases.

Conclusions

PFE is a common injury in persons following major blunt trauma, occurring acutely within the first few minutes after the insult. In individuals in whom no other plausible cause of death is found at autopsy, the forensic pathologist must consider PFE as a potential cause of death or as an important factor contributing to the onset of death.