title: Chest radiographic evolution in fat embolism syndrome.
abstract: OBJECTIVE
  To characterize the temporal chest radiographic findings of fat embolism syndrome.
  
  
  METHODS
  Twenty-nine patients with clinically diagnosed fat embolism syndrome between 1988-1999 were retrospectively identified from the Trauma Registry of Haborview Medical Center, University of Washington. In twenty-two patients, complete medical records and serial chest radiographs were available. All images were reviewed by a dedicated thoracic radiologist.
  
  
  RESULTS
  Two of 22 patients had normal radiographs throughout hospitalization, while 20/22 developed abnormal chest radiographs. The radiographic findings were consistent with non-specific diffuse pulmonary edema in all abnormal cases. The time to appearance of evident radiographic lung injury was < 24 hours of initial trauma in 10/20 (50%), between 24-48 hours in 4/20 (20%), between 48-72 hours in 5/20 (25%), and 1 patient (1/20, 5%) developed an abnormal chest radiograph after 72 hours. Ten of 20 patients (50%) with abnormal radiographs had complete resolution of the edema pattern within 1 week of development of opacities, 3/20 (15%) cases showed complete radiographic resolution between 1-2 weeks, 2/20 (10%) cases showed complete radiographic resolution between 2-3 weeks, 1/20 (5%) showed complete radiographic resolution between 3-4 weeks, and 4/20 (20%) died without resolution of the radiographic finding.
  
  
  CONCLUSIONS
  The chest radiographic appearance of fat embolism syndrome is non-specific. Normal radiographs can also be seen. Most patients presenting with a normal initial radiograph develop radiographic evident abnormalities within 72 hours of injury and most cases showed radiographic resolution within 2 weeks of hospitalization. Although chest imaging play a little role in the clinical management of fat embolism syndrome, understanding of temporal presentation and evolution of the otherwise non-specific pulmonary opacities may help to avoid unnecessary evaluation in selected patients.
authors.affiliation: Department of Radiology, Faculty of Medicine, Siriaj Hospital, 2 Prannok Rd, Bangkoknoi, Bangkok 10700, Thailand. mailtonisa@gmail.com
authors.forename: Nisa
authors.initials: N
authors.lastname: Muangman
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Stern
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: Fred A
authors.initials: FA
authors.lastname: Mann
mesh_terms: D000328:Adult; D000368:Aged; D004620:Embolism, Fat / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic