**4. Risk factors**

76 Pulmonary Embolism

Fig. 1. Different sub-types of NTPE (Reproduced with permission – Jorens et al, ERJ 2009)

manifestations often described as Fat Embolism Syndrome (FES).

**3. Epidemiology** 

FES is rare.

peripheral and pulmonary circulation. It can range from being asymptomatic to life threatening respiratory failure with or without neurological and other systemic

The reported incidence of FE & FES varies widely in literature. FE occurs in great majority of patients who sustain pelvic or long-bone fractures, endo-medullary nailing of longbone fractures or placement of knee and hip prosthesis. Embolic showers of circulating fat globules have been demonstrated in up to 41% of patients following surgical nailing of long bone fractures (Talbot & Schemitsch, 2006). However, only a small percentage of these patients develop FES (406th Medical General Laboratory, Professional Section, 1951; Deland, 1956; Gossling & Pellegrini, 1982; Gurd & Wilson, 1974; Koessler et al., 2001; Levy, 1990; Lozman et al., 1986; Palmovic & McCarroll, 1965; Peltier, 1969; Shier & Wilson, 1980; Talbot & Schemitsch, 2006). The incidence of posttraumatic FES can range from 0.25% (Peltier, 1969) to 35% (Gurd & Wilson, 1974; Lindeque et al., 1987; Riska & Myllynen, 1982). The timing of the fracture fixation also appears to impact the incidence of FES. Delayed surgery predisposes to a higher incidence. Non-traumatic FE or Trauma, orthopedic procedures and soft tissue injuries including severe burns are by far the most common causes of FE and FES. FES is more likely to develop after pelvic or lower extremity fractures; it is seldom observed in patients with isolated upper extremity fractures.


Table 1. Traumatic Fat Embolism - Factors predisposing to FES among Trauma patients

Non-Thrombotic Pulmonary Embolism 79

Pancreatitis (Bulger et al., 1997; Godeau et al.,

1996; Goldhaber, 2004; Guardia et al., 1989; Jenkins et al., 2002; M. B. King & Harmon, 1994; Lynch, 1954; Richards, 1997; Robert et al., 1993)

Goldhaber, 2004; M. B. King & Harmon, 1994; Richards, 1997;

2004; Hutchinson et al., 1973; Jenkins et al., 2002; M. B. King & Harmon, 1994; Richards, 1997;

2002; M. B. King & Harmon, 1994; Levy, 1990; Patil & Wakankar, 2008; Richards, 1997; Robert et al., 1993;

Davison, 1950; Jenkins et al., 2002; M. B. King & Harmon, 1994; Ober et al., 1959; Richards, 1997; Robert et

Harmon, 1994; Richards, 1997; Weinhouse, January 2011)

Wagner, 1865)

Robert et al., 1993)

Weisz, 1974)

al., 1993)

**7. Conditions associated with fat embolization (Table-3)** 

Panniculitis (Goldhaber, 2004)

Alcoholic fatty liver (Goldhaber, 2004)

Liquefying subcutaneous hematoma (Jorens et al., 2009)

Viral hepatitis in pre-existing fatty liver (Schulz et al., 1996)

Bone tumor lysis (Weinhouse, January 2011)

Burns ( Bulger et al., 1997; Jenkins et al.,

Decompression sickness (Bulger et al., 1997; Haymaker &

Diabetes mellitus (Cuppage, 1963; M. B. King &

Table 3. Diseases related

Osteomyelitis ( Broder & Ruzumna, 1967;

Sickle cell crisis ( Bulger et al., 1997; Goldhaber,
