Anesth Pain Med.  2018 Jan;13(1):77-81. 10.17085/apm.2018.13.1.77.

A case of life-threatening intraoperative diffuse alveolar hemorrhage during a femur fracture operation with suspected fat embolism: A case report

• Suh JH
• Lee BS
• Baek SJ
• Park SK
• Cho EJ

• KMID: 2436060
• DOI: http://doi.org/10.17085/apm.2018.13.1.77

Abstract

Diffuse alveolar hemorrhage (DAH) is a rare manifestation of trauma or long bone fracture. A relationship between fat embolism and DAH has been reported. A 73-year-old female developed sudden cardiac arrest during a femur fracture operation. Cardiopulmonary resuscitation (CPR) was repeated for about 130 minutes. During CPR, blood was detected in the endotracheal tube. Diffuse patch ground glass opacity appearance and increased pulmonary artery with bulging of interventricular septum toward the left ventricle were detected on a chest computed tomography scan. After full supportive care including ventilator therapy, the patient's condition became stabilized and she was extubated after 7 days. We report a case of DAH in the course of a suspected fat embolism during femur fracture operation. Although DAH is a rare manifestation of fat embolism, early diagnosis and aggressive treatment likely can decrease morbidity and mortality.

Keyword

Diffuse alveolar hemorrhage; Embolism; Long bone fracture

MeSH Terms

Aged
Cardiopulmonary Resuscitation
Death, Sudden, Cardiac
Early Diagnosis
Embolism
Embolism, Fat*
Female
Femur*
Fractures, Bone
Glass
Heart Ventricles
Hemorrhage*
Humans
Mortality
Pulmonary Artery
Thorax
Ventilators, Mechanical

Figure

• 

  Fig. 1 Chest computed tomography scan shows diffuse patch ground glass opacity appearance and increased pulmonary artery size with bulging of the interventricular septum toward the left ventricle. Ao: aorta, PA: pulmonary artery, RA: right atrium, RV: right ventricle, LV: left ventricle, arrow: bulging of the interventricular septum toward the left ventricle.

• 

  Fig. 2 (A) Chest radiography shows diffuse hazy infiltration in both lungs. (B) Chest radiography shows infiltration in both lungs had decreased on postoperative day 5.

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