INTRODUCTION
Fat embolism syndrome (FES) typically occurs after major trauma
generally involving fractures of the pelvis and/or the femur and
manifests clinical symptoms 12–72 h after the
insult1. It is a clinical diagnosis made based on the
symptoms of cerebral symptoms, respiratory distress, petechial rash with
or without acute circulatory failure, kidney injury, thrombocytopenia,
anaemia and so on2. It is also known that FES develops
after bone fixation surgery3. Although fat entering
from the fractured bone marrow into the systemic circulation plays a
vital role, detection of fat in blood has not been widely performed for
diagnosing FES, and the significance of fat globules in blood remains
unknown.
In this report, we describe a case of a trauma patient who developed two
episodes of severe circulatory and respiratory compromise that finally
resulted in cardiac arrest presumably due to FES. In particular, we
retrospectively investigated the serial changes in fat globules in the
blood smear samples of this patient in association with clinical
deterioration.