Abstract
Background. Fat embolism syndrome is difficult to diagnose because of its nonspecific findings on examination. Case. An 87-year-old woman with dementia fell on the floor and fractured the neck of her left femur, and she was admitted to a local hospital. After 2 days, she experienced dyspnea, and her chest radiograph showed diffuse abnormal shadows in both the right and left lungs. She was then transferred to our hospital. Chest computed tomography (CT) showed ground glass opacities and pleural effusion in both lungs. Fat embolism syndrome was suspected, but the results of her physical examination and laboratory tests did not yield a definitive diagnosis. Therefore, we performed bronchoalveolar lavage and identified macrophages containing fat droplets; furthermore, the number of neutrophils and T-cell subset CD4/8, as well as the level of granulocyte elastase, were elevated. We diagnosed fat embolism syndrome and treated the patient with steroid pulse therapy, after which the abnormal shadows on her chest CT disappeared. Conclusion. Bronchoalveolar lavage is an useful diagnostic technique in patients who don't fulfill the diagnostic criteria but are suspected fat embolism syndrome strongly.
