CTICasesFat Embolism Syndrome
Imaging findings
Chest CT in a patient presenting with acute dyspnea four days after total hip arthroplasty revision (pelvic acetabular component replacement) shows diffuse, bilateral ground-glass opacities with a lobular pattern of involvement and sharp margins against spared lobules. Echo shows acute right ventricular enlargement and septal straightening, indicating pulmonary hypertension. The condition resolved after steroid therapy.
Key takeaways
Fat embolism syndrome (FES) is a rare, life-threatening complication of orthopedic surgery (such as hip arthroplasty or intramedullary nailing) or long bone fractures. Manipulating the marrow cavity releases fat globules into the systemic veins, obstructing pulmonary capillaries. Subsequent hydrolysis of the fat releases toxic free fatty acids, triggering chemical pneumonitis and ARDS, which is managed with supportive care and steroids.
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