PMC6317091_01
Right Femur X-Ray showing acute femur fracture (black arrow).
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A 56-year-old male with a history of hypothyroidism and hyperlipidemia was admitted to the hospital after a motor vehicle accident where he sustained a closed right subtrochanteric femur fracture with 4 cm of foreshortening [Figure 1].
Brain MRI revealed multiple bilateral acute cerebral infarcts (black arrows) with restricted diffusion areas in a "starfield" pattern favoring fat emboli.
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Magnetic resonance imaging (MRI) of the brain revealed multiple bilateral acute cerebral infarcts with restricted diffusion areas in a "starfield" pattern favoring the diagnosis of cerebral fat embolism [Figure 2].
CXR showed diffuse bilateral infiltrates in a "snowstorm" pattern.
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Within the first 48 hours of ICU admission he developed a bilateral patchy opacity in a "snowstorm" pattern on chest X-Ray [Figure 3] and his BNP (brain natriuretic peptide) was 24 (normal 0-100 pg/mL).
Anterior chest wall petechial rash (black arrows).
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There was a petechial rash noted on his anterior chest [Figure 4].
Transesophageal echocardiogram showing significant R to L shunt (white arrow).
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Further workup demonstrated a patent foramen ovale (PFO) with a significant right to left shunt [Figure 5] by transesophageal echocardiogram (TEE).
White arrow showing 3 bubbles crossing the atrial septum on transesophageal echocardiogram.
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There was also a positive bubble study [Figure 6].