A 30 year old male patient presents with the following symptoms, breathlessness, irritability and confusion. He gives a history of fracture of his right arm 3 days ago. On physical examination, a diffuse petechial rash is seen. Blood examination reveals thrombocytopenia. The most likely diagnosis for this patient will be?
Correct Answer: Fat embolism syndrome
Description: Symptomatic fat embolism syndrome is characterized by pulmonary insufficiency, neurologic symptoms, anemia, thrombocytopenia, and a diffuse petechial rash that is fatal in 10% of cases.
Clinical signs and symptoms appear 1 to 3 days after injury as the sudden onset of tachypnea, dyspnea, tachycardia, irritability, and restlessness, which can progress rapidly to delirium or coma. Thrombocytopenia is attributed to platelet adhesion to fat globules and subsequent aggregation or splenic sequestration; anemia can result from similar red cell aggregation and/or hemolysis. A diffuse petechial rash (seen in 20%–50% of cases) is related to rapid onset of thrombocytopenia and can be a useful diagnostic feature.
The pathogenesis of fat emboli syndrome involves both mechanical obstruction and biochemical injury. Fat microemboli occlude pulmonary and cerebral microvasculature, both directly and by triggering platelet aggregation. This deleterious effect is exacerbated by fatty acid release from lipid globules, which causes local toxic endothelial injury. Platelet activation and granulocyte recruitment (with free radical, protease, and eicosanoid release) complete the vascular assault.
Robin’s Textbook of pathology 10th ed Page 112
Category:
Pathology
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