Jan 1, 2013 - William J. Scotton1, Katherina Kohler1, Judith Babar1, Dawn Russell-Hermanns1, and. Edwin R. Chilvers1. 1University of Cambridge School of ...
Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences Fat Embolism Syndrome with Purtscher’s Retinopathy William J. Scotton1, Katherina Kohler1, Judith Babar1, Dawn Russell-Hermanns1, and Edwin R. Chilvers1 1 University of Cambridge School of Clinical Medicine and Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
A 25-year-old man was admitted after a collapse at home. He had sustained a closed tibial fracture 2 days previously while playing rugby, and was treated with a back-slab in Accident and Emergency that afternoon. On returning home, he noticed worsening blurred vision and shortness of breath. The following morning, he was found unconscious in his bed, and was brought in by ambulance to the hospital. On admission he was postictal, pyrexial (38.28 C), tachypneic (26 breaths/min), and hypoxemic (PaO2 57.1 mm Hg breathing air) with a Glasgow Coma Score of 10/15. The only past history was a basal skull fracture sustained as a child. His head computed tomography (CT) scan was normal, but the CT chest showed extensive bibasal and posterior bronchovascular consolidation consistent with acute lung injury (Figure 1A). Although there was no suggestion of aspiration clinically or on CT, he was treated with intravenous antibiotics in addition to oxygen. Although his conscious level and breathlessness resolved rapidly, he then complained of visual blurring and myodesopsia, which persisted. Fundoscopy revealed bilateral cotton wool spots (Figure 1B, arrows) at the posterior poles with macular edema and multiple hemorrhages. A diagnosis of fat embolism syndrome with Purtscher’s retinopathy was made. He was treated conservatively and although he made a good recovery from a respiratory perspective, he continues to have blurred vision with an acuity of 6/24 in both eyes at 6 months. Author disclosures are available with the text of this article at www.atsjournals.org.
Figure 1.
Author Contributions: Conception/design/acquisition of data—W.J.S., K.K., J.B., D.R.H., E.R.C. Drafting and revising of manuscript—W.J.S., K.K., J.B., D.R.H., E.R.C. Final approval of manuscript for publication—W.J.S., K.K., J.B., D.R.H., E.R.C. Am J Respir Crit Care Med Vol 187, Iss. 1, p 106, Jan 1, 2013 Copyright ª 2013 by the American Thoracic Society DOI: 10.1164/rccm.201205-0881IM Internet address: www.atsjournals.org
