An unusual case of pulmonary fat embolism following blunt trauma

  • Danica Cvetković
  • Vladimir Živković
  • Slobodan NikolićEmail author
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Fat embolism is markedly underdiagnosed, even though it is a well-known phenomenon following fractures of the long bones, injury to subcutaneous fat tissue, rupture of a fatty liver, surgical operations on fatty tissues, septicemia, burns and barotrauma. Forensic pathologists tend to “simplify” autopsy report conclusion in cases with multiple injuries where fat embolism and exsanguination could be considered to be the concomitant causes of death. Herein we present a case of 24-year-old male who was beaten with a metal rod by several persons. On admission to hospital his vital signs and laboratory findings indicated hemorrhagic shock with gradual respiratory failure; he died 17 h after injury. On internal autopsy examination the subcutaneous tissue of the limbs and back was severely bruised, corresponding to about 35% of the body surface area. He had fractures of several small bones. Injuries of the internal organs were absent, there was no free blood in the body cavities, and all other autopsy findings were unremarkable but suggestive of a significant blood loss. Microscopic examination showed a massive pulmonary fat embolism (grade III according to Sevitt), without systemic fat embolism. The cause of death was attributed to pulmonary fat embolism combined with severe blood loss, following extensive and severe bruising of the subcutaneous tissues and bone fractures.


Autopsy Fat embolism Pulmonary fat embolism Nonfracture-associated Blunt trauma Subcutaneous tissue 



This work was supported by the Ministry of Science of the Republic of Serbia, Grant No. 45005.

Compliance with ethical standards

Conflict of interest

The authors hereby declare that they have no conflict of interest. The paper has been presented as poster presentation (P6) at 26th Alpe-Adria-Pannonia International meeting on Forensic Medicine that has been held in Pula, Croatia, from 30 May until 02 June 2018.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Forensic MedicineUniversity of Belgrade – School of MedicineBelgradeSerbia

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