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NEUROIMAGE
Year : 2018  |  Volume : 66  |  Issue : 4  |  Page : 1206-1207

Fat embolism following a liposuction procedure


1 Department of Neurology, Chinese PLA General Hospital, Beijing; Department of Cerebral Vascular Diseases, Sanya People's Hospital, Sanya, China
2 Department of Cerebral Vascular Diseases, Sanya People's Hospital, Sanya, China
3 Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Sanya, China

Date of Web Publication18-Jul-2018

Correspondence Address:
Dr. Cui Fang
Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Haitang Bay, Sanya 572013, Hainan Province
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.236965

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How to cite this article:
Zhibin Z, Peng S, Fang C. Fat embolism following a liposuction procedure. Neurol India 2018;66:1206-7

How to cite this URL:
Zhibin Z, Peng S, Fang C. Fat embolism following a liposuction procedure. Neurol India [serial online] 2018 [cited 2018 Aug 17];66:1206-7. Available from: http://www.neurologyindia.com/text.asp?2018/66/4/1206/236965




A 40-year old lactating woman was transferred to the emergency room following deterioration of her consciousness after liposuction of a large area of her arms and abdomen. She had a left-gaze predominance, with left sided hemiplegia where the motor movements did not even respond to painful stimulation, and Babinski's sign was positive on both the sides. The arterial blood gas analysis and lung computed tomographic (CT) scanning were normal. The brain CT scan [Figure 1]a 7 h after the liposuction procedure showed a mild low intensity signal in the left hemisphere and a black signal in a deep area within the left Sylvian fissure. Fourteen hours after the liposuction procedure, widespread petechiae developed on her chest, back, and arms. Brain magnetic resonance imaging (MRI) showed large areas of hyperintense foci on T2-weighted and diffusion-weighted images in the deep gray matter, including the left lentiform nucleus, thalami, and bilateral caudate nuclei, and the left cortical area including the left frontal, temporal, and occipital lobes [Figure 1]b and [Figure 1]c. The history of liposuction, the disturbance in consciousness, the petechial rashes on the skin, and the CT/MRI findings prompted a diagnosis of fat embolism. The black signal seen on the CT scan image [[Figure 1]a, arrow] was considered to be representative of a fat droplet, which had blocked an artery and was also shown on diffusion-weighted images as an interval in the continuum of hyperintensity signal of the vessel [Figure 1]c, arrow]. Large amounts of fat droplets had embolized to the distal arteries and the watershed area was uninvolved. Although many therapeutic measures were given, her condition deteriorated due to a combination of factors, including the development of cerebral herniation, pneumonia, acute renal insufficiency, and hepatic failure. She died of multiple organ dysfunction syndrome (MODS) on the 13 day after the liposuction procedure.
Figure 1: (a) Brain CT showed mild low intensity lesions in the left cerebral hemisphere and a black signal (arrow) in a deep area within the Sylvian fissure. (b) Brain MRI (T2-weighted images) showed hyperintense foci in deep gray matter and the left cortical area. (c) Brain MRI (diffusion-weighted images) showed high signals in the deep gray matter and the left cortical area

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Fat embolism is a syndrome caused by dissemination of fat particles, which can lead to blockage of the vessels of multiple organs. The syndrome often occurs after long-bone fractures or an orthopedic surgery and rarely after liposuction.[1] Actually, fat embolism after the performance of a liposuction is more severe than due to other etiologies, with a 15% risk of death.[1] The diagnosis of fat embolism is established based upon a combination of manifestations including a petechial rash, respiratory distress, and mental disturbances.[1] Fat droplet signals in the brain scan have been reported only once previously by Yamamoto et al.[2] Cerebral infarction was located in the distribution area of the distal arteries, including the left internal carotid artery and posterior cerebral artery; the characteristic starfield appearance that is usually seen following the occurrence of fat embolism was missing.[3],[4] We speculate that the poor outcome and the unique imaging findings were caused by fat embolism precipitated by liposuction. During the procedure, very large amounts of fat particles entered the circulatory system. This was in contrast to the usual findings during fat embolism associated with long-bone fractures or an orthopedic surgery, where the numbers of fat particles disseminating throughout the body, including the brain, are fewer.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wang HD, Zheng JH, Deng CL, Liu QY, Yang SL. Fat embolism syndromes following liposuction. Aesthetic Plast Surg 2008;32:731-6.  Back to cited text no. 1
    
2.
Yamamoto K, Kushimoto S. Subarachnoidal fat droplet deposition and fat embolism syndrome. BMJ Case Rep 2017:bcr-2017-221493.  Back to cited text no. 2
    
3.
Goenka N, Ropper AH. Images in clinical medicine. Cerebral fat embolism. N Engl J Med 2012;367:1045.  Back to cited text no. 3
    
4.
Chatterjee R, Nagar VS, Sajjan B, Patel K. Nonconvulsive status in the trauma centre: Think of cerebral fat embolism. Neurol India 2017;65:1420-2.  Back to cited text no. 4
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