Medical Image of the Week: Fat Embolism Syndrome

A 33-year-old man presented to the emergency department with shortness of breath and hemoptysis. He was discharged two days prior after hospitalization for a motor vehicle accident, in which he suffered a fracture of the shaft of the right femur. He had undergone open reduction and internal fixation of the fracture four days prior to this admission. He had diffuse parenchymal disease on his admission chest x-ray. A CT scan of the chest demonstrated multilobar ground glass opacities (Figure 1).

Figure 1. Thoracic CT scan showing ground glass opacities.

Bronchoscopy demonstrated progressively bloody BAL aliquots in two different lobes, consistent with diffuse alveolar hemorrhage (DAH). His workup for other etiologies was negative, and he was given a diagnosis of DAH secondary to fat embolism syndrome.

Joshua Malo, MD and Kenneth S. Knox, MD

Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine

University of Arizona, Tucson, AZ

Reference as: Malo J, Knox KS. Medical image of the week: fat embolism syndrome. Southwest J Pulm Crit Care. 2014;8(4):246. doi: http://dx.doi.org/10.13175/swjpcc041-14 PDF

Medical Image of the Week: Lung Cancer with Vascular Invasion

Figure 1. Panel A: Representative axial view of the thoracic CT scan showing tumor invading the left atrium via the right superior pulmonary vein (arrow). Panel B: Coronal view showing tumor invasion (arrow).

A 73-year-old woman presented to the emergency department with seizures and a subacute history of mild dyspnea on exertion. Her admission chest x-ray demonstrated a large right upper lobe lung mass, and MRI of the brain demonstrated multiple bilateral enhancing lesions concerning for a cardiac embolic source. Representative axial (Figure 1A) and coronal (Figure 1B) images from her chest CT scan demonstrate tumor invading the left atrium via the right superior pulmonary vein (arrow). The tumor was confirmed to be small cell carcinoma of the lung.

Joshua Malo, MD and Franz Rischard, DO

Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine

University of Arizona, Tucson, AZ 

Reference as: Malo J, Rischard F. Medical image of the week: lung cancer with vascular invasion. Southwest J Pulm Crit Care. 2014;8(4):235. doi: http://dx.doi.org/10.13175/swjpcc040-14 PDF