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Age: 25

Sex: Female

Indication: Trauma

Save ("V")

Case #37


Findings

  • Chest
    • Anterior mediastinal fat stranding
  • Abdomen/Pelvis
    • Stranding adjacent to the left femoral vein
    • Focal fat density filling defect in the left external iliac vein
    • Flattening of the IVC
    • Circumaortic left renal vein
    • Mild hepatomegaly
    • Adreniform thickening of the left adrenal gland without discrete nodule
    • Submucosal colonic fat deposition, which may represent sequela of prior inflammation
    • Urinary bladder is decompressed around a Foley catheter
  • MSK
    • Acute comminuted sternal fracture
    • Acute nondisplaced bilateral anterior second through fifth rib fractures
    • Acute nondisplaced fracture of the right anterior acetabular wall extending into the pubic root and superior acetabulum
    • Partially imaged comminuted right intertrochanteric femoral fracture with subtrochanteric extension
    • Large left breast/neck/shoulder hematoma with subcutaneous emphysema
    • Soft tissue stranding in the ventral abdominal wall


Diagnosis

  • Fat embolism

Sample Report

Fat embolism in the left external iliac vein.

Stranding adjacent to the left femoral vein raises concern for vascular injury though there is no evidence of active hemorrhage.

Flattening of the IVC, which can be seen with hypovolemia.

Large left breast/neck/shoulder hematoma and stranding in the ventral abdominal wall, compatible with seatbelt injury.

Comminuted sternal fracture with small anterior mediastinal hematoma. No evidence of aortic trauma.

Acute nondisplaced bilateral anterior second through fifth rib fractures.

Acute nondisplaced right acetabular fracture. Right hip is located.

Partially imaged comminuted right intertrochanteric femoral fracture with subtrochanteric extension.


Discussion

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Images

Fat embolism in the left external iliac vein (red arrow). Left tibial and fibular fractures in this patient.



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