103 Fat Emboli Syndrome

Clinical Presentation

86-year-old man with new onset of dyspnea and non-productive cough developing five days following vertebroplasty of a symptomatic L1-L2 compression fracture. Respiratory failure developed over the following several days.

Radiologic Findings

PA (Fig. 103.1A) and lateral (Fig. 103.1B) chest radiographs demonstrate diffuse ground glass and reticular opacities throughout the right lung with associated volume loss. Unenhanced chest CT through the upper (Figs. 103.1C, 103.1D), mid (Fig. 103.1E), and lower (Fig. 103.1F) lung zones (lung window) reveal a diffuse “crazy-paving” pattern throughout the right lung with some foci of intervening normal lung. Mild bronchial and bronchiolar dilatation is seen in the affected lung. Subtle foci of ground glass and reticular opacities are present in the peripheral left lung. Unenhanced CT (mediastinal window) through the mid-thorax (Fig. 103.1G) and upper abdomen (Fig. 103.1H, 103.1I) shows high-attenuation polymethylmethacrylate in the anteromedial basal and lateral basal arterial divisions of the left lower lobe (Fig. 103.1F) and also emanating out from the L1 vertebroplasty site, with linear tracts extending into the paravertebral and extradural venous plexus into the right renal vein (Figs. 103.1H, 103.1I).