Clinicopathologic Study of Pulmonary Fat Embolism in Fatty Liver

Kwon, Tae Jung; Kang, Hyun Wook

Abstract

Fat embolism is the presence of fat globules in the peripheral circulation and in the lung, brain, kidney, heart, and so on -not in the fine emulsion of a metabolic lipemia but in globules large enough to obstruct arterioles and capillaries. The fat droplets can derive from fractures of long bone due to disruption of the fatty marrow, from extensive bruising of the soft tissue, and from fat tissue in burns. Fat embolism has also been reported in patients suffering from various diseases including alcoholism, fatty liver, diabetes mellitus and pancreatitis. We investigated 19 autopsies with fatty liver of varying degrees to establish a correlation between fatty change of liver and pulmonary fat embolism. Among 19 cases, 3 cases with moderate to severe fatty change of liver, and 1 case with submassive hepatic necrosis and mild fatty change showed Grade II pulmonary fat embolism. In histologic section with Sudan III stain, the arteries and capillaries of lung were occupied and distended by round, oval, or staghorn fat globules. The alveoli may contain edema fluid and blood. Although the pulmonary fat embolism occuring in the presented cases didn't cause death on its own, one should be aware that a life-threatening mobilization of fat into the lungs and even into the systemic circulation is possible in fatty liver and submassive hepatic necrosis.