A case of fatal fulminant fat embolism syndrome following multiple fractures resulting from a fall

• Published in: Journal of Forensic Sciences Vol. 67; no. 5; pp. 2115 - 2121
• Main Authors: Hirata, Yuichiro, Inokuchi, Go, Tsuneya, Shigeki, Hoshioka, Yumi, Chiba, Fumiko, Yoshida, Maiko, Makino, Yohsuke, Iwase, Hirotaro
• Format: Journal Article
• Language: English
• Published: Colorado Springs Wiley 01.09.2022; Wiley Subscription Services, Inc
• Subjects: Arteries; Autopsies; autopsy; Bathing; Bones; Computed tomography; Death; Embolisms; Falls; fat embolism; Fatalities; fat‐fluid level; Forensic pathology; Fractures; fulminant fat embolism syndrome; Globules; Lungs; postmortem CT; Pulmonary arteries; Staining; Trauma
• ISSN: 0022-1198; 1556-4029; 1556-4029
• DOI: 10.1111/1556-4029.15083

Fat embolism syndrome is a life‐threatening condition in which fatty substances enter the circulation and cause respiratory distress and neurological symptoms. It can occur following trauma and severe fat embolism occurring soon after trauma is known as fulminant fat embolism syndrome. Although fat staining of the lungs is helpful for diagnosing fat embolism syndrome at autopsy, clinical and other information is needed to determine the relationship between cause of death and the syndrome. In this report, we describe the macroscopic, microscopic, and computed tomography (CT) findings specific for fat embolism that were observed in a patient with fulminant fat embolism syndrome who died soon after the injury. An 85‐year‐old woman fell from a bath stretcher during assisted bathing and died 3 h later. Autopsy revealed fractures of the left femoral neck and other bones, as well as large amounts of fat‐like material in the right and left pulmonary arteries. Histological examination of the lung with Oil red O staining showed extensive fat vacuoles. Based on these findings and postmortem CT images of the fractures and fatty globules in the pulmonary arteries detected prior to death, the cause of death was determined to be blunt force trauma, with fat embolism syndrome playing a significant role. This case is an example of fulminant fat embolism, which can be fatal in a short period of time, and demonstrates that CT performed postmortem but before autopsy can be useful in detecting fat embolism syndrome due to trauma.