Fulminating Fat Embolism Syndrome Caused by Paradoxical Embolism through a Patent Foramen Ovale

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Abstract
The post-traumatic fat embolism syndrome is a multisystem disorder characterized by pulmonary and neurologic dysfunction, pyrexia, and a petechial rash1-4. More than a century after the first descriptions of the fat embolism syndrome, the cause of fat emboli and the pathogenesis of the systemic manifestations of this disorder remain incompletely understood. We describe a patient undergoing treatment of a femoral fracture in whom massive fat embolism was demonstrated by transesophageal echocardiography. Acute cor pulmonale developed, precipitating paradoxical fat embolism across a patent foramen ovale, with the subsequent development of the fat embolism syndrome. Embolism of fat across a patent foramen ovale is a possible mechanism responsible for the systemic features of fat embolism syndrome.