Key result
A 24-year-old man with a closed femur fracture developed concurrent fat embolism syndrome and pulmonary embolism, with a patent foramen ovale identified on echocardiography.
Case Report (n=1)
Routine echocardiography may be beneficial in patients with pulmonary embolism to identify right-to-left shunts like PFO that increase the risk of paradoxical systemic embolism.
May warrant echocardiography to detect PFO in PE after long-bone fracture; leaves open whether routine screening improves outcomes.
We present a rare case of a patient with concurrent fat embolism and pulmonary embolism, in a closed femur fracture with patent foramen ovale (PFO). A 24-year-old man was involved in a motor vehicle accident with a closed left midshaft femur fracture. He developed fat embolism syndrome (FES) on day 3 of admission, and plating was performed. The D-dimer concentration was also high, which raised the suspicion of pulmonary artery embolism. Computed tomography pulmonary angiography (CTPA) revealed right inferior lobar pulmonary artery embolism and FES. A transthoracic echocardiogram (TEE) was performed, which showed a PFO. The presence of a PFO in patients with pulmonary embolism increases the risk of systemic embolism. Therefore, we recommend the routine echocardiogram for patients with pulmonary embolism to exclude any cardiac defect in causing right-to-left shunts, which predisposes the patient to paradoxical embolism.
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Siew Khei Liew (2020) conducted a case report in Concurrent fat embolism syndrome and pulmonary embolism with patent foramen ovale (n=1). A 24-year-old man with a closed femur fracture developed concurrent fat embolism syndrome and pulmonary embolism, with a patent foramen ovale identified on echocardiography.
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