fibrin and Embolism--Fat

This report describes how a finding at the autopsy table led to the observation of a clinical syndrome. A synthesis of autopsy experience, clinical investigations, and experimental and biochemical studies were able to shed light on one factor in the pathogenesis of this syndrome, namely blood coagulation with pulmonary microemboli and release and delayed elimination of peptides from fibrin degradation extravascularly in the lungs. These peptides may both induce increased permeability in the microcirculation and stimulate fibroblast proliferation. Knowledge about the pathogenesis has led to improved prophylaxis and therapy and a reduction of the number of deaths.

Topics: Antifibrinolytic Agents; Autopsy; Blood Coagulation; Capillary Permeability; Cell Division; Embolism, Fat; Fibrin; Fibrin Fibrinogen Degradation Products; Fibroblasts; Humans; Microcirculation; Pulmonary Embolism; Shock; Syndrome

Topics: Abruptio Placentae; Amniotic Fluid; Embolism, Air; Embolism, Fat; Female; Fetal Death; Fibrin; Humans; Inhalation; Pregnancy; Pregnancy Complications, Cardiovascular; Pulmonary Circulation; Pulmonary Embolism; Pulmonary Heart Disease; Thrombophlebitis

Fat embolization following major trauma is reported to be a quite common event, while the clinical fat embolism syndrome (FES) seems to be a much rarer event. Fat embolism occurs in 2 up to 23% of patients with isolated femoral shaft fractures. This complication appears to be related not only to the fracture, but also to the timing of stabilization. Sometimes it may be impossible to perform histochemical reactions on frozen sections to detect fat emboli thus confirming diagnosis or suspicion of FES. The finding of fibrinogen and platelets around the apparently empty spaces in the blood vessels has been proposed as an evidence for vital reaction due to either a vital cellular reaction or a flotation mechanism, thus supporting an intravital fat embolism. We report a fatal case due to fat embolism syndrome in a young man hospitalized for a right femoral neck fracture, treated with orthopaedic surgery and subjected to an intra-surgery transesophageal echocardiography that revealed embolization of numerous highly echogenic bodies. Four hours after the onset of clinical symptoms the man died from respiratory failure. The autopsy confirmed the clinical diagnosis of fat embolism syndrome. The histological examination revealed a large amount of fat globules in cerebral and pulmonary arteries and in glomerular capillaries, as well as fibrin and platelet deposition confirmed by the positive results by Sudan III staining for lipids and immunohistochemistry with anti-CD61 and anti-fibrinogen antibodies. The quantitative classification of fat embolism was grade 3 of Sevitt's classification or grade 4 of Fineschi's quantification, according to the current quantitative microscopic methods used for grading fat embolism in pulmonary tissue.

Topics: Adult; Antibodies; Blood Platelets; Capillaries; Echocardiography, Transesophageal; Embolism, Fat; Femoral Neck Fractures; Fibrin; Fibrinogen; Forensic Pathology; Humans; Immunohistochemistry; Integrin beta3; Lung; Male; Microscopy, Confocal; Pulmonary Artery; Respiratory Insufficiency; Syndrome

The authors studied the pathological aspects of the lungs in an experimental study made in dogs submitted to fat embolism. The histological aspects were of hemorrhagic edema when the lungs were fixed in the classical way as well when they were fixed inflated. The alveolar microatelectasias were only seen in lungs fixed in the classical way but not were seen in lungs fixed when inflated.

Topics: Animals; Dogs; Embolism, Fat; Fatty Acids, Unsaturated; Fibrin; Lipids; Lung; Male; Oleic Acids; Pulmonary Alveoli; Pulmonary Edema; Triglycerides

Topics: Animals; Blood Vessels; Embolism, Fat; Fibrin; Lung; Microscopy, Electron; Platelet Aggregation; Pulmonary Embolism; Rats; Triolein

Topics: Adolescent; Adult; Aged; alpha 1-Antitrypsin; Blood Platelets; Embolism, Fat; Fibrin; Fibrinogen; Fibrinolysis; Fractures, Bone; Hematocrit; Humans; Macroglobulins; Middle Aged; Plasminogen

Topics: Animals; Biopsy; Blood Coagulation Tests; Bone and Bones; Collagen; Disease Models, Animal; Disseminated Intravascular Coagulation; Dogs; Embolism, Fat; Exudates and Transudates; Fibrin; Fractures, Bone; Hindlimb; Hypoxia; Leukocytes; Lung; Microscopy; Microscopy, Electron; Muscles; Musculoskeletal System; Pulmonary Edema; Pulmonary Embolism; Triolein

Topics: Animals; Autoradiography; Clinical Enzyme Tests; Disease Models, Animal; Dogs; Embolism, Fat; Fibrin; Fibrinogen; Iodine Isotopes; Methods; Oleic Acids; Pulmonary Artery; Staining and Labeling

Topics: Angiography; Animals; Blood Coagulation Disorders; Disseminated Intravascular Coagulation; Embolism, Fat; Escherichia coli Infections; Female; Fibrin; Infarction; Kidney; Kidney Cortex Necrosis; Kidney Diseases; Kidney Glomerulus; Lipids; Rabbits; Shwartzman Phenomenon; Toxemia; Triglycerides

Topics: Accidents, Traffic; Aged; Autopsy; Blood Coagulation Disorders; Embolism, Fat; Female; Femoral Fractures; Fibrin; Fracture Fixation, Intramedullary; Fractures, Bone; Humans; Intracranial Embolism and Thrombosis; Lipids; Lung; Male; Middle Aged; Pelvic Bones; Pulmonary Artery; Pulmonary Embolism; Pulmonary Veins; Tibial Fractures; Time Factors; Wounds and Injuries

Topics: Animals; Blood Coagulation Disorders; Disseminated Intravascular Coagulation; Embolism, Fat; Endotoxins; Fibrin; Lipids; Lipopolysaccharides; Mice; Rabbits; Sulfonic Acids; Trypsin

Topics: Adipose Tissue; Animals; Blood Coagulation Factors; Blood Coagulation Tests; Blood Platelets; Embolism, Fat; Factor V; Female; Fibrin; Fibrinogen; Fractures, Bone; Heparin; Hindlimb; Injections, Intravenous; Iodine Isotopes; Lipids; Lung; Pulmonary Embolism; Rabbits; Rats; Thrombosis

Topics: Adipose Tissue; Aminocaproates; Animals; Blood Coagulation; Blood Coagulation Factors; Blood Coagulation Tests; Embolism, Fat; Female; Femoral Fractures; Fibrin; Fibrinolysis; Hemoglobinometry; Hemolysis; Phagocytosis; Plasminogen; Premedication; Pulmonary Embolism; Rats; Serum Albumin, Radio-Iodinated; Trypan Blue

Topics: Diagnosis, Differential; Embolism, Fat; Fibrin; Heparin; Humans; Hypertension, Pulmonary; Injections, Intravenous; Pulmonary Embolism; Time Factors

Topics: Autopsy; Bronchitis; Burns; Embolism, Fat; Fibrin; Humans; Lung; Pneumonia; Pulmonary Alveoli; Pulmonary Artery; Pulmonary Embolism; Pulmonary Veins; Thoracic Injuries

Topics: Embolism; Embolism, Fat; Female; Fibrin; Hemorrhage; Hemorrhagic Disorders; Humans; Postpartum Hemorrhage; Postpartum Period; Pulmonary Embolism

Topics: Embolism; Embolism, Fat; Fibrin; Food; Humans; Intracranial Embolism; Intracranial Embolism and Thrombosis; Thrombosis