Unusual clinicopathological presentation of nontraumatic cerebral fat embolism: Two-case report

Fat embolism following fat grafting: A systematic review of reported cases

Background

This systematic review aims to consolidate and analyze reported cases of fat embolism following fat grafting, focusing on patient demographics, procedural characteristics, clinical features, diagnostic methods, management strategies, and outcomes.

Methods

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted across multiple databases, including PubMed, Google Scholar, Cochrane, Embase, MEDLINE, and Scopus, up to January 31, 2024. Inclusion criteria encompassed case presentations diagnosing fat embolism or fat embolism syndrome post-fat grafting in patients over the age of 18 years. Data were extracted using EndNote® X21.

Results

From 1051 identified studies, 71 met inclusion criteria, encompassing 137 patients. The mean patient age was 36.22 years, with 90.5 % being female. Liposuction was the predominant fat harvesting method. Ocular signs were the most common presentation (50.8 %), followed by neurological (42.2 %) and cardiopulmonary (32.0 %) symptoms. Diagnostic methods varied, including imaging and histopathology. Supportive care was the primary management strategy. The overall mortality rate was 34.3 %, with 88.6 % of survivors experiencing permanent sequelae.

Discussion

This study acknowledges several limitations in evidence, including heterogeneity, recall bias, language limitations, and potential publication bias due to studies with worse outcomes. Fat embolism following fat grafting, though rare, can lead to significant morbidity and mortality. Early recognition and prompt management are crucial. This review highlights the need for standardized diagnostic and treatment protocols to improve patient outcomes in fat grafting procedures.

Other

This study received no external funding and was previously registered with the Prospective International Register of Systematic Reviews (PROSPERO).

Fat embolism: the hidden murder for trauma patients!

INTRODUCTION

fat embolism syndrome (FES) is an acute respiratory disorder that occurs when an inflammatory response causes the embolization of fat and marrow particles into the bloodstream. The exact incidence of FES is not well defined due to the difficulty of diagnosis. FES is mostly associated with isolated long bone trauma, and it is usually misdiagnosed in other trauma cases. The scope of this study was to identify and search the current literature for cases of FES in nonorthopedic trauma patients with the aim of defining the etiology, incidence, and main clinical manifestations.

METHODS

we perform a literature search via the PubMed journal to find, summarize, and incorporate reports of fat embolisms in patients presenting with non-orthopedic trauma.

RESULTS

the final literature search yielded 23 papers of patients presenting with fat embolism/FES due to non-orthopedic trauma. The presentation and etiology of these fat embolisms is varied and complex, differing from patient to patient. In this review, we highlight the importance of maintaining a clinical suspicion of FES within the trauma and critical care community.

CONCLUSION

to help trauma surgeons and clinicians identify FES cases in trauma patients who do not present with long bone fracture, we also present the main clinical signs of FES as well as the possible treatment and prevention options.

Exploring Superselective Intraarterial Thrombolysis for Autologous Fat Injection-Induced Vision Loss

BACKGROUND

Intravascular injection represents the most severe complication in fat transplantation procedures. Currently, the prognosis for patients who suffer from blindness due to fat transplantation-induced ocular vascular occlusion is far from optimistic.

OBJECTIVES

The aim of this study was to explore and evaluate the efficacy and safety of arterial thrombolysis in the treatment of ocular vascular occlusion caused by fat transplantation.

METHODS

We analyzed the data of 12 patients who underwent intraarterial thrombolysis and conservative treatments for facial autologous fat grafting-associated ocular vascular occlusion. Among the cases, there were 6 instances of ophthalmic artery embolism and 6 cases of central retinal artery occlusion. All patients suffered with sudden blindness, sometimes accompanied by eye pain, ptosis, strabismus, skin necrosis at the injection site, or cerebral microinfarction. They received symptomatic conservative treatments and intraarterial thrombolysis, encompassing mechanical vessel recanalization, vessel dilation, and dissolution of thrombus constituents.

RESULTS

Following intraarterial thrombolysis, a noteworthy improvement in the blood flow of both the main trunk and peripheral branches of the ophthalmic artery was observed in the majority of patients when contrasted with their pretreatment status. One patient experienced a headache intraoperatively, while no significant discomfort was reported by the remaining patients. After conservative treatments and intraarterial thrombolysis, all patients experienced improvement in ocular symptoms, skin necrosis, and cerebral infarction. Three patients demonstrated improvement in visual acuity. These patients had surpassed the recommended time window for treatment, yet the occlusion of the ophthalmic artery was not complete.

CONCLUSIONS

Intraarterial thrombolysis combined with conservative treatments achieves early perfusion and is expected to promote visual recovery. Hospitals that possess the necessary treatment capabilities are encouraged to establish this therapeutic pathway.

Do you know the diagnostic importance of susceptibility-weighted imaging on MRI for patients with cerebral fat embolism?

Key Clinical Message

If you suspect cerebral fat embolism (CFE) of the diagnosis for the patients who present with impaired consciousness and hypoxia following a fracture, susceptibility-weighted imaging should be included of head MRI imaging.

Abstract

We report a case of cerebral fat embolism (CFE) that could be identified only by susceptibility-weighted imaging (SWI). Collection and analysis of previous case reports of CFE revealed utilization of SWI in less than one third of suspected cases, despite its known diagnostic ability for CFE.

Case report and literature review: fatal cerebral fat embolism following facial autologous fat graft

Background

Severe cerebral artery embolism is a rare complication of facial autologous fat injection. However, its incidence has markedly increased with the recent rise in facial cosmetic procedures.

Case presentation

We report a 31-year-old Chinese woman who presented with unconsciousness 6 h after having undergone a facial autologous fat injection. A neurological examination revealed stupor, bilaterally diminished pupillary light reflexes, right-sided central facial palsy, and no reaction to pain stimulation of right limbs. Diffusion-weighted imaging displayed patchy hyperintense lesions in the left frontal, parietal, and temporal lobes. Magnetic resonance angiography demonstrated fat embolism in the left internal carotid artery, anterior cerebral artery, and middle cerebral artery. We immediately performed mechanical thrombectomy under sufficient preoperative preparations but failed to achieve complete recanalization. Pathological examination of the embolus confirmed the presence of adipocytes. Although we actively administered symptomatic and supportive treatments, the patient eventually died due to the progression of cerebral herniation and systemic infection.

Conclusion

Due to the ineffectiveness of current treatment and the inferior prognosis, fat embolism, a severe complication of autologous fat graft, should draw the attention of both plastic surgeons and neurologists so that actions may be taken for both its prevention and treatment.

Cerebral Large Vessel Occlusion Caused by Fat Embolism-A Case Series and Review of the Literature

The diagnosis of fat embolism syndrome typically involves neurological, respiratory and dermatological manifestations of microvascular occlusion 24–72 h after a precipitating event. However, fat embolism causing cerebral large vessel occlusion strokes and their sequelae have rarely been reported in the literature. This case series reports three patients with fat emboli post operatively causing cerebral large vessel occlusions, as well as a review of the literature to identify differences in clinical presentations and outcomes in stroke secondary to fat emboli causing large vessel occlusions compared to those with fat embolism syndrome.

Severe Vascular Complications Caused by Facial Autologous Fat Grafting: A Critical Review

BACKGROUND

Vascular embolism is the most severe complication after autologous fat grafting. With a worldwide increase in fat grafting, there has been a rise in severe vascular complications, such as ophthalmic artery embolism, cerebral artery embolism, and even death. This article aims to review the role of fat in causing severe vascular complications and the association between fat grafting and severe vascular complications.

METHODS

A critical review was conducted by appraising the cases of severe vascular complications associated with facial fat grafting reported globally. Repeated cases that were reported in multiple publications were further screened.

RESULTS

The final search yielded 50 publications in English that met the inclusion criteria for review. A total of 113 cases of fat-induced severe vascular complications in the literature were identified. The number of cases reported yearly has increased over time, with even more significant increases since 2010. The glabella and temple are the most common sites of severe vascular complications described in the literature. In addition, only one case of ophthalmic artery embolism and one case of cerebral artery embolism have been treated successfully.

CONCLUSIONS

Given the increase in reported cases of severe vascular complications, both doctors and patients should pay careful attention to the risks of facial fat grafting. Because of the unclear mechanism of vascular embolism and the lack of guidelines for prevention and treatment, the effective cure rate is unsatisfactory. We propose that preventing vascular embolism is a priority in fat grafting and that timely, multidisciplinary treatment should be performed when severe vascular complications occur. It is necessary in future studies to explore the mechanisms of vascular embolism and effective treatment strategies to promote the development of fat grafting.