BRONCHOALVEOLAR LAVAGE FOR RAPID DIAGNOSIS OF THE FAT-EMBOLISM SYNDROME IN TRAUMA PATIENTS

被引:75
作者
CHASTRE, J [1 ]
FAGON, JY [1 ]
SOLER, P [1 ]
FICHELLE, A [1 ]
DOMBRET, MC [1 ]
HUTEN, D [1 ]
HANCE, AJ [1 ]
GIBERT, C [1 ]
机构
[1] INSERM, U82, F-75005 PARIS, FRANCE
关键词
D O I
10.7326/0003-4819-113-8-583
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To evaluate the usefulness of bronchoalveolar lavage in establishing the diagnosis of the fat embolism syndrome in trauma patients with long-bone fractures. Design: Case series. Setting: Referral hospital. Patients: Eighteen trauma patients with long-bone fractures, including 5 with definite fat embolism syndrome, 5 in whom the diagnosis had been clinically suspected but was impossible to confirm or exclude before bronchoscopy, and 8 with no clinical evidence of the syndrome. Control groups included 9 patients without previous trauma who developed the adult respiratory distress syndrome for various reasons and 15 normal volunteers. Measurements and Main Results: Each patient had fiber-optic bronchoscopy with bronchoalveolar lavage, and the percentage of lavage cells containing intracellular fat droplets stained with oil red O were determined. In the five patients with definite fat embolism syndrome, light microscopic study of bronchoalveolar cells stained with oil red 0 showed many large intracellular fat droplets (mean percentage of cells containing fat droplets, 63%; range, 31% to 82%), whereas less than 2% of cells recovered by lavage from trauma patients with no clinical evidence of the syndrome, from patients with the adult respiratory distress syndrome, or from normal volunteers contained such inclusions. Use of the same technique in the five patients with possible fat embolism syndrome permitted the immediate identification of three patients in whom this diagnosis was later confirmed by subsequent autopsy or clinical follow-up. Conclusions: The identification of fat droplets within cells recovered by bronchoalveolar lavage in trauma patients may be a rapid and specific method for establishing the diagnosis of the fat embolism syndrome.
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页码:583 / 588
页数:6
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共 20 条
  • [11] PULMONARY MICROVASCULAR CYTOLOGY - A NEW DIAGNOSTIC APPLICATION OF THE PULMONARY-ARTERY CATHETER
    MASSON, RG
    RUGGIERI, J
    [J]. CHEST, 1985, 88 (06) : 908 - 914
  • [12] FAT EMBOLI SYNDROME
    MOYLAN, JA
    BIRNBAUM, M
    KATZ, A
    EVERSON, MA
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1976, 16 (05) : 341 - 347
  • [13] ADULT RESPIRATORY-DISTRESS SYNDROME IN PATIENTS WITH SEVERE NEUTROPENIA
    OGNIBENE, FP
    MARTIN, SE
    PARKER, MM
    SCHLESINGER, T
    ROACH, P
    BURCH, C
    SHELHAMER, JH
    PARRILLO, JE
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1986, 315 (09) : 547 - 551
  • [14] PELTIER LF, 1988, CLIN ORTHOP RELAT R, V232, P263
  • [15] EARLY DIAGNOSIS OF FAT-EMBOLISM SYNDROME
    POLLAK, R
    MYERS, RAM
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1978, 18 (02) : 121 - 123
  • [16] FAT MACRO-GLOBULEMIA CAUSED BY FRACTURES OR TOTAL HIP-REPLACEMENT
    RENNE, J
    WUTHIER, R
    HOUSE, E
    CANCRO, JC
    HOAGLUND, FT
    [J]. JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1978, 60 (05) : 613 - 618
  • [17] REYNOLDS HY, 1987, AM REV RESPIR DIS, V135, P250
  • [18] FAT-EMBOLISM PROPHYLAXIS WITH CORTICOSTEROIDS - A PROSPECTIVE-STUDY IN HIGH-RISK PATIENTS
    SCHONFELD, SA
    PLOYSONGSANG, Y
    DILISIO, R
    CRISSMAN, JD
    MILLER, E
    HAMMERSCHMIDT, DE
    JACOB, HS
    [J]. ANNALS OF INTERNAL MEDICINE, 1983, 99 (04) : 438 - 443
  • [19] FAT-EMBOLISM PROPHYLAXIS - STUDY OF 4 TREATMENT MODALITIES
    SHIER, MR
    WILSON, RF
    JAMES, RE
    RIDDLE, J
    MAMMEN, EF
    PEDERSEN, HE
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1977, 17 (08) : 621 - 629
  • [20] NEUTROPHILS AND THE ADULT RESPIRATORY-DISTRESS SYNDROME
    TATE, RM
    REPINE, JE
    [J]. AMERICAN REVIEW OF RESPIRATORY DISEASE, 1983, 128 (03): : 552 - 559