Fat Embolism Syndrome - Diagnostic Dilemma During Covid-19 Pandemic

Abstract

Acute onset of breathlessness and type 1 respiratory failure in young patients in the orthopaedic ward with traumatic pelvic or long bone fractures often raise suspicion of thromboembolic event, classic fat embolism and fat embolism syndrome (FES). However, in the era of the prevailing pandemic, the clinical presentation may cause suspicion of Covid-19 infection, creating a dilemma for diagnostic purposes, causing inadvertent delays in definitive management. Although clinically significant in 30 % of cases, FES in subclinical form is believed to be occurring in a large percentage of patients with long bone and pelvic fractures, secondary to a rise in intramedullary pressure and venous sinusoidal disruption. Debris of bone and fat gain access to the systemic and pulmonary circulation cause mechanical obstruction as well as multi-organ dysfunction syndrome. FES can be recognised by classic Bergman’s triad1 characterised by hypoxaemia, petechial rash and mental changes. We present a case of fat embolism syndrome that was reported in a tertiary care centre during the peak of the Covid19 pandemic.