From the Research
The recommended confirmatory tests for fat embolism syndrome (FES) include arterial blood gas analysis, brain MRI with diffusion-weighted imaging, chest radiography, CT scans, bronchoalveolar lavage (BAL), and serum biomarkers, with a focus on CT scans of the chest to detect ground-glass opacities and interlobular septal thickening, as suggested by the most recent study 1. The diagnosis of FES is based on a combination of clinical criteria and laboratory findings, and no single test is pathognomonic for FES.
- Arterial blood gas analysis typically reveals hypoxemia, which is a hallmark of FES.
- Brain MRI with diffusion-weighted imaging can show characteristic findings indicating cerebral microemboli.
- Chest radiography may demonstrate bilateral patchy infiltrates, though these findings often lag behind clinical symptoms by 12-24 hours.
- CT scans of the chest can detect ground-glass opacities and interlobular septal thickening earlier than conventional radiographs, as noted in the study 1.
- Bronchoalveolar lavage may reveal fat droplets in alveolar macrophages when stained with Oil Red O or Sudan Black.
- Serum biomarkers including lipase, phospholipase A2, and D-dimer may be elevated, though these are not specific to FES, as mentioned in the study 2. The study 3 highlights the importance of early definitive fracture fixation in preventing further fat embolism and ongoing organ dysfunction, and the study 4 notes that the presence of nodules at CT examination may be a helpful finding in the diagnosis of FES. The diagnosis of FES typically relies on a combination of clinical criteria (such as Gurd's or Schonfeld's criteria) supported by these laboratory and imaging findings in the appropriate clinical context, usually following long bone fractures, orthopedic procedures, or severe trauma, as discussed in the study 5.