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Fat embolism is the next common form after thromboembolism. More than 90 % cases occur after fracture of long bones or, rarely due to trauma to the fatty area and extensive burn involving subcutaneous fat. Pathogenesis: There is mechanical obstruction to the pulmonary vessels by micro-emboli of neutral fat producing local accumulation of platelets and red blood cells with liberation of free fatty acids. Free fatty acids cause toxic injury to endothelium, activation of platelets and recruitment of granulocytes (free radicals, proteases, and eicosanoids). Clinical presentation: Clinically (fat embolism syndrome), there is sudden pulmonary insufficiency beginning 1 to 3 days after injury. Most of the patients develop a diffuse petechial rash and some may have neurological symptoms (irritability and restlessness). This is followed by delirium and coma. Thrombocytopenia and anemia may also occur. These are fatal up to 10% cases.
Diagnosis: Fat stain of frozen section reveals micro-vascular fat globules. Microscopically, edema and hemorrhage and hyaline membrane in lungs may be seen.
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