Fulminating Fat Embolism Syndrome Caused by Paradoxical Embolism through a Patent Foramen Ovale

The post-traumatic fat embolism syndrome is a multisystem disorder characterized by pulmonary and neurologic dysfunction, pyrexia, and a petechial rash1–4. More than a century after the first descriptions of the fat embolism syndrome, the cause of fat emboli and the pathogenesis of the systemic manifestations of this disorder remain incompletely understood. We describe a patient undergoing treatment of a femoral fracture in whom massive fat embolism was demonstrated by transesophageal echocardiography. Acute cor pulmonale developed, precipitating paradoxical fat embolism across a patent foramen ovale, with the subsequent development of the fat embolism syndrome. Embolism of fat across a . . .