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In the wake of the novel coronavirus disease 2019 (COVID-19) pandemic and its associated mortality and virulence, a high clinical suspicion must be maintained for all patients presenting with respiratory failure. However, there are well-known disease processes that may have a similar presentation. We present a case of a 25-year-old male who suffered a right tibia fracture after a motor vehicle collision. He had acute hypoxic respiratory failure within 24 hours of admission, requiring mechanical ventilation. His condition significantly improved with airway pressure release mode of ventilation and proning. Although his chest CT demonstrated characteristic findings of COVID-19, he subsequently tested negative. The differential included aspiration pneumonia and fat embolism syndrome from the lower extremity fracture. Fat embolism syndrome can very closely mimic COVID-19. The rapid onset and improvement of symptoms coupled with serial negative COVID-19 testing may aid in the diagnosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Faizi et al.)

Fat Embolism Syndrome (FES) is a rare condition where circulating fat emboli can lead to life threatening multisystem dysfunction. Diagnosis of FES occurs mainly by exclusion. The aim of this study was to describe the injury, event details, and factors associated with the diagnosis of FES following trauma presenting to a Level 1 Trauma Centre in Melbourne, Australia. Medical records of all patients with a complication of FES between 2006 and 2018 were retrospectively reviewed. Demographics, injury factors, hospital event details, radiological procedures and length of stay were collected. Thirty six patients, with median age of 26 years (IQR 19, 42) and median Injury Severity Score (ISS) of 18.5 (IQR 10, 27) were diagnosed with FES. Other associated factors included male gender (86%) and having one or more long bone fractures (97%). Of the major FES diagnostic criteria, 94% of patients experienced hypoxia, 36% had mental status changes, whereas only 11% had petechiae. Computed Tomography Pulmonary Angiogram (CTPA) was performed on 19 patients (53%) with all being negative for pulmonary embolus. Most demonstrated ground glass opacity (58%), and FES was reported as the likely cause of patient presentation in 53% of cases. FES following trauma was rare, with its diagnosis based on clinical factors including long bone fracture and hypoxia, and the exclusion of other respiratory diagnoses. CTPA was frequently used since 2008 and further research is warranted to determine if this radiological procedure can assist with more definitive diagnosis of FES. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To measure the amount of fat presented to the right heart during reaming and nail placement using two different reamer systems. Design: Prospective, randomized clinical trial. Setting: University-based Level I Trauma Center. Patients: 20 patients with femur fractures. Intervention: Patients with femur fractures were treated with intramedullary nailing using either reamer-irrigator-aspirator or a conventional reamer. Main Outcome Measure: four-chamber trans-esophageal echocardiogram was used to quantify the amount of fat presented to the right atrium. Results: There were 2 female and 18 male patients enrolled, 10 in each group. There was no significant difference (p=0.10) between reaming systems on the opening reamer, which was expected since both trial limbs used the same opening reamer. However, during the first pass of the reamer, the RIA showed a nearly-significant decrease in the volume of fat in the right atrium (p=0.06). During passage of the nail, there was a significant difference with Group B having less fat embolus than Group A (p=0.01). The power of this study is 0.81. The mean ISS was not significantly different between the two groups, nor was the sex, age or race. There was one death from cardiac complications in a patient who showed no fat during any phase of the procedure. This patient had significant mitral and aortic regurgitation pre-operatively. There was one patient with clinical fat embolism syndrome and one patient with a nonunion. Conclusions: There is a statistically significant difference in the amount of fat presented to the lungs using a RIA versus conventional reamer. [ABSTRACT FROM AUTHOR]