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[重症医学影像]:脂肪栓塞综合征
2017年09月13日 临床影像, 临床话题 暂无评论

Imaging in Intensive Care Medicine

Fat embolism syndrome

Anselmo Caricato, Giovanni Russo, Daniele Guerino Biasucci, Maria Giuseppina Annetta

Intensive Care Med 2017; 43: 1411-1412

A 19-year-old man was admitted to our emergency department after a road accident. He presented with bilateral femoral fractures that were promptly treated with external fixators. After surgery, he was monitored in ICU. Twenty-four hours after admission, fever, tachycardia, dyspnea, and hypoxia appeared. He also became drowsy but arousable, confused, and agitated. Tracheal intubation was performed. A few hours later, reddish-brown nonpalpable axillary (Fig. 1a) and subconjunctival petechiae (Fig. 1b) appeared. Brain CT and chest X-ray were normal. Suspecting a fat embolism syndrome, we performed an MRI that showed multiple hyperintense puntiform lesions disseminated in deep white substance, basal ganglia, and thalamus on FLAIR imaging (Fig. 1c) and multiple microembolic infarcts (“starfield pattern”) on DWI (Fig. 1d). Transesophageal echocardiography excluded septal defects, and an electroencephalogram showed a generalized polymorphic delta activity. Urine analysis was normal, but lipiduria was observed. After 5 days the patient was extubated and 2 days later he was discharged by the ICU with good recovery. Skin alterations persisted for 4 days after ICU discharge.

一名19岁男性患者于车祸后就诊于急诊科。患者双侧股骨骨折接受了外固定手术。术后收入ICU进行监测。24小时后,患者出现发热,心动过速,呼吸困难及低氧。患者还表现为昏睡,但仍可唤醒,意识模糊且躁动。遂进行气管插管。数小时后,患者腋窝(图1a)及结膜下(图1b)出现红褐色淤点。头颅CT及胸部X片正常。因怀疑患者罹患脂肪栓塞综合征,我们进行了MRI检查,FLAIR显像结果显示,深层白质、基底节及丘脑散在多发高密度点状病灶(图1c),DWI显像提示多发微栓塞坏死(图1d)。经食道心脏超声检查排除了室间隔缺损,脑电图显示广泛多形性delta波。尿液检查正常,但有脂肪尿。5天后拔除气管插管,2天后患者恢复良好,从ICU转出。皮肤病变在转出ICU后仍持续4天。

Fig. 1 Classic cutaneous signs of fat embolism syndrome are shown: axillary (a) and subconjunctival petechiae (b). Multiple disseminated lesions are observed on FLAIR (c) and DWI (d)

Fat embolism syndrome is a clinical diagnosis that is based on the classic triad of hypoxemia, neurologic abnormalities, and petechial rash. Treatment is largely supportive. In severe cases clinical signs may persist for several days, but recovery is usually complete.

脂肪栓塞综合征系根据临床典型三联症(低氧血症,神经系统异常及出血点)做出的临床诊断。治疗主要为支持性。严重病例临床体征可持续数日,但通常可完全恢复。

 

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