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.