Embolic Disease

Thromboembolic Disease

X-ray

Septic Emboli

X-ray

Fat Embolism

Nearly all result from trauma, usually leg fractures
Pathologically, fat embolism is very common (as high as 97% after injury)
Carried via bloodstream as neutral triglycerides and converted by pulmonary lipase to unsaturated fatty acids
Most common in young people with leg fractures in MVAs and older people with hip fractures or post-arthroplasty
Clinical

X-ray

Full picture takes 1– 3 days following trauma (DDX from lung contusion)
Chest x-ray is usually normal
Typical appearance is a pulmonary edema-like picture sometimes affecting the periphery or the bases more than CHF does

Amniotic Fluid Embolism

Develops only if fetal products (skin and meconium) enter maternal blood stream
Onset is immediate
Filtered out in the pulmonary vascular bed, the particles produce pulmonary arterial hypertension, shock, pulmonary edema, hypoxemia
May produce rapidly fatal anaphylactic reaction or DIC
Predisposing conditions include:

X-ray

· Pulmonary edema indistinguishable from CHF (DDX: massive pulmonary hemorrhage and Mendelsohn’s syndrome)

Oil Embolism

· Occurs 100% of the time following lymphangiography

· Most who demonstrate it on x-ray have lymphatic obstruction

· Manifests as very fine granular, then reticular interstitial pattern

· Rarely produces symptoms

May be introduce by drug abusers, those attempting suicide, or for “muscle quickness”
Characteristic appearance in lungs of diffuse metal density
Goes to the dependent portion of the lung at the time of injection
Produces mild inflammatory reaction
Excretion is via kidneys

WH/’91