Fat embolism syndrome physical examination

Fat embolism syndrome(FES) is characterized by multisystem dysfunction most commonly presents in 12 to 72 hours after the initial insult. It is a clinical diagnosis and requires high degree of suspicion. The classic triad of clinical manifestations are petechiae, hypoxemia and neurological abnormalities. Pulmonary manifestations are the most common initial signs of FES and include dyspnea, tachypnea, hypoxemia, and respiratory failure of which the hypoxemia is the earliest feature that. Other findings on physical examination are retinal exudates, scotomatas and intravascular fat globules.

The physical examination findings more commonly appear after 12-72 hours of the initial insult. The classic triad of clinical manifestations seen on physical examination in fat embolism syndrome include the following:^[1][2][3][4]

• Petechiae
• Neurological deficits^[5][6]
• Hypoxemia

The following findings are seen on general physical examination:

• Petechiae: Reddish brown non-palpable rash
• Appear within 24-36 hours and disappear within a week in 20-50% of patients.
• Classically seen in the non-dependent regions such as:
  • Axillae
  • Conjunctiva
  • Anterior thorax
  • Head and neck
• Tachypnea
• Tachycardia
• Lethargy
• Cyanosis

The following physical exam findings are seen on neurological examination. They are present mainly due to cerebral edema:^[7]

• Focal neurological deficit
• Confusion
• Rigidity
• Convulsions
• Anisocoria
• Conjugate eye deviation
• Coma

Fundoscopic examination shows the following changes in the retina:^[8][9][10]

• Exudates
• Intravascular fat globules
• Edema
• Hemorrhage
• Retinal scotomata (Purtscher’s retinopathy)