A case of fat embolism syndrome during surgical graft replacement of the descending aorta for blunt aortic injury

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  • 鈍的大動脈損傷に対する胸部下行大動脈置換術中に発症した脂肪塞栓症候群の1例

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Abstract

A 26-year-old male suffered a right femoral fracture and a blunt injury of the descending aorta in a traffic accident. On admission, he was mostly alert. External fixation of the femoral fracture was followed by a surgical graft replacement of the descending aorta for the treatment of blunt aortic injury. After starting percutaneus cardiopulmonary support, light-bloody bubbling secretions from the trachea were observed and his oxygenation suddenly deteriorated. Thereafter, hypoxemia, high fever, tachycardia, and a disturbance of consciousness continued for several postoperative days. We detected some petechiae on his chest wall on the 5th day after the admission. We diagnosed fat embolism syndrome based on the presence of the petechiae and other clinical symptoms of the patients. The physical condition of the patient gradually improved after the administration of corticosteroids, however, the disturbance of consciousness continued to deteriorate. Magnetic resonance imaging of the brain on the 21st day after the admission showed the typical findings of fat embolism syndrome. In the present case, it was difficult to diagnose fat embolism syndrome because of the sudden onset of the syndrome during surgical graft replacement of the descending aorta for the treatment of blunt aortic injury.

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