Post-Trauma Combined Pulmonary Fat and Bone Embolism: Literature Review with Case Presentation

Abstract

Following an accident in the workplace, a man received deep wounds in his left groin and left lower limb caused by plow blades. An external examination was carried out showing multiple, large, and deep slash injuries of the scrotal region, the left groin, and the left thigh. A complete autopsy was performed. The gross examination of the lungs showed edema and congestion, with some areas of parenchymal contusion and wide emphysema. The left femur showed complete, comminuted, displaced, and exposed fracture of its diaphyseal tract. Histopathological analysis was then carried out, showing unusual abnormalities in both lungs, with numerous endovascular drop-shaped fat globules with surrounding hematopoietic marrow that were mixed with small bone particles. The other organs did not show any signs that could explain the death. Given macroscopic and histopathological elements, the cause of death was ultimately identified as a traumatic shock with a high hemorrhagic component combined with pulmonary bone marrow and bone embolism. This paper aims to outline a rare case of post-trauma combined bone and bone marrow embolism. This occurrence is scantly described in the literature and should be considered in major trauma deaths. Therefore, in such cases, an accurate histopathological analysis should be mandatory to identify the correct cause of death and evaluate a possible medical liability.