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A woman in her late 20s presented one week after an abdominoplasty surgical procedure to the emergency room complaining of shortness of breath and chest pain. A chest computed tomography angiogram (CTA) pulmonary embolism protocol (PE) was ordered to rule out acute PE. The CTA study was negative for PE, but an incidental finding of complete obstruction of the right subclavian vein was noted.

Fat embolism syndrome (FES) is defined as a variant of posttraumatic pulmonary insufficiency following long-bone musculoskeletal trauma or surgical repair. FES is a serious life-threatening complication characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae. Although frequently asymptomatic and commonly seen following bone manipulation, fatty emboli are rarely found in patients undergoing total joint arthroplasty. Embolic signals from fatty emboli have been detected by transesophageal echocardiography (TTE) and transcranial Doppler (TCD); however, they have rarely been documented in the lower extremity. A patient is described with multiple fatty emboli demonstrated during a venous duplex examination.