重症医学影像脂肪栓塞综合征

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ImaginginIntensiveCareMedicineFatembolismsyndromeAnselmoCaricato,GiovanniRusso,DanieleGuerinoBiasucci,MariaGiuseppinaAnnettaIntensiveCareMed;43:-

A19-year-oldmanwasadmittedtoouremergencydepartmentafteraroadaccident.Hepresentedwithbilateralfemoralfracturesthatwerepromptlytreatedwithexternalfixators.Aftersurgery,hewasmonitoredinICU.Twenty-fourhoursafteradmission,fever,tachycardia,dyspnea,andhypoxiaappeared.Healsobecamedrowsybutarousable,confused,andagitated.Trachealintubationwasperformed.Afewhourslater,reddish-brownnonpalpableaxillary(Fig.1a)andsubconjunctivalpetechiae(Fig.1b)appeared.BrainCTandchestX-raywerenormal.Suspectingafatembolismsyndrome,weperformedanMRIthatshowedmultiplehyperintensepuntiformlesionsdisseminatedindeepwhitesubstance,basalganglia,andthalamusonFLAIRimaging(Fig.1c)andmultiplemicroembolicinfarcts(“starfieldpattern”)onDWI(Fig.1d).Transesophagealechocardiographyexcludedseptaldefects,andanelectroencephalogramshowedageneralizedpolymorphicdeltaactivity.Urineanalysiswasnormal,butlipiduriawasobserved.After5daysthepatientwasextubatedand2dayslaterhewasdischargedbytheICUwithgoodrecovery.Skinalterationspersistedfor4daysafterICUdischarge.

一名19岁男性患者于车祸后就诊于急诊科。患者双侧股骨骨折接受了外固定手术。术后收入ICU进行监测。24小时后，患者出现发热，心动过速，呼吸困难及低氧。患者还表现为昏睡，但仍可唤醒，意识模糊且躁动。遂进行气管插管。数小时后，患者腋窝（图1a）及结膜下（图1b）出现红褐色淤点。头颅CT及胸部X片正常。因怀疑患者罹患脂肪栓塞综合征，我们进行了MRI检查，FLAIR显像结果显示，深层白质、基底节及丘脑散在多发高密度点状病灶（图1c），DWI显像提示多发微栓塞坏死（图1d）。经食道心脏超声检查排除了室间隔缺损，脑电图显示广泛多形性delta波。尿液检查正常，但有脂肪尿。5天后拔除气管插管，2天后患者恢复良好，从ICU转出。皮肤病变在转出ICU后仍持续4天。

Fig.1Classiccutaneoussignsoffatembolismsyndromeareshown:axillary(a)andsubconjunctivalpetechiae(b).MultipledisseminatedlesionsareobservedonFLAIR(c)andDWI(d)

Fatembolismsyndromeisaclinicaldiagnosisthatisbasedontheclassictriadofhypoxemia,neurologicabnormalities,andpetechialrash.Treatmentislargelysupportive.Inseverecasesclinicalsignsmaypersistforseveraldays,butrecoveryisusually







































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那里治疗白颠风