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Farid M, Zohny E, Ismail A, Ateya M, Abdel-Razek A, Hamed N, Elmarakby A, Hassanin A, Ismail A, Mansour O, Roshdy H, Ahmed Y, Ismail M, Amin HAA. Bone marrow embolism: should it result from traumatic bone lesions? A histopathological human autopsy study. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00609-2. [PMID: 37133760 DOI: 10.1007/s12024-023-00609-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 05/04/2023]
Abstract
Bone marrow embolism (BME) is likely a consequence of fractures in which pulmonary vessels are the most affected. However, some cases of BME were reported in the absence of trauma. Thus, a traumatic injury might not be necessary for developing BME. This study discusses BME cases in patients without signs of fractures or blunt trauma. The discussion addresses various possible mechanisms for the appearance of BME. Options include cancer in which bone marrow metastasis is a suggestive cause. Another proposal is the chemical theory where bone marrow fats are released via lipoprotein lipase in a pro-inflammatory state, resulting in vascular/pulmonary obstruction. Other cases discussed in this study are hypovolemic shock and drug-abuse related BME. All autopsy cases with BME were included regardless of the cause of death for a period of 2 years. Autopsies involved complete dissection with the macroscopic evaluation of the affected organs, including the heart, lungs, and brain. Tissues were also prepared for microscopic examination. Of the 11 cases, eight showed non-traumatic BME (72%). These findings conflict with theories in the literature that BME most commonly occurs after fractures or trauma. One of the eight cases exhibited mucinous carcinoma; one is presented with hepatocellular carcinoma; and two cases showed severe congestion. Lastly, one case was found to be associated with each of the following conditions: liposuction, drug abuse, pulmonary hypertension, and heart failure. Each case suggests a different pathophysiology for developing BME, yet the exact mechanisms are not fully understood. Further study of non-traumatic associated BME is recommended.
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Affiliation(s)
- Maha Farid
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Helwan University, Cairo, Egypt.
| | - Esraa Zohny
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Alaa Ismail
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mariem Ateya
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | | | - Nermien Hamed
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | | | - Arwa Hassanin
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmed Ismail
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Omar Mansour
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Hossam Roshdy
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Yehia Ahmed
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mariam Ismail
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Hebat Allah A Amin
- Department of Pathology, Faculty of Medicine, Helwan University, Cairo, Egypt
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Cutts S, Talboys R, Paspula C, Prempeh EM, Fanous R, Ail D. Adult respiratory distress syndrome. Ann R Coll Surg Engl 2017; 99:12-16. [PMID: 27513791 PMCID: PMC5392788 DOI: 10.1308/rcsbull.2017.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2016] [Indexed: 06/06/2023] Open
Abstract
Adult respiratory distress syndrome (ARDS) has now been described as a sequela to such diverse conditions as burns, amniotic fluid embolism, acute pancreatitis, trauma, sepsis and damage as a result of elective surgery in general. Patients with ARDS require immediate intubation, with the average patient now being ventilated for between 8 and 11 days. While the acute management of ARDS is conducted by the critical care team, almost any surgical patient can be affected by the condition and we believe that it is important that a broader spectrum of hospital doctors gain an understanding of the nature of the pathology and its current treatment.
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Affiliation(s)
- S Cutts
- James Paget Hospital NHS Foundation Trust , Great Yarmouth , UK
| | - R Talboys
- James Paget Hospital NHS Foundation Trust , Great Yarmouth , UK
| | - C Paspula
- Kings Lynn Hospital , Kings Lynn , UK
| | | | - R Fanous
- London North West Healthcare Trust , UK
| | - D Ail
- James Paget Hospital NHS Foundation Trust , Great Yarmouth , UK
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Abstract
Adult respiratory distress syndrome (ARDS) has now been described as a sequela to such diverse conditions as burns, amniotic fluid embolism, acute pancreatitis, trauma, sepsis and damage as a result of elective surgery in general. Patients with ARDS require immediate intubation, with the average patient now being ventilated for between 8 and 11 days. While the acute management of ARDS is conducted by the critical care team, almost any surgical patient can be affected by the condition and we believe that it is important that a broader spectrum of hospital doctors gain an understanding of the nature of the pathology and its current treatment.
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Affiliation(s)
- S Cutts
- James Paget Hospital NHS Foundation Trust , Great Yarmouth , UK
| | - R Talboys
- James Paget Hospital NHS Foundation Trust , Great Yarmouth , UK
| | - C Paspula
- Kings Lynn Hospital , Kings Lynn , UK
| | | | - R Fanous
- London North West Healthcare Trust , UK
| | - D Ail
- James Paget Hospital NHS Foundation Trust , Great Yarmouth , UK
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