PMC8403578_01
Select chest imaging in FES.. CXR on day of admission (a) and hospital day three (b) showing interval development of diffuse bilateral hazy opacities. CT Angiography of lungs at three days after initial injury in axial (c) and coronal (d) sections. Note dilated pulmonary trunk in (c) and presence of diffuse infiltrates and ground glass opacities, consistent with RV strain in the setting of hypoxic respiratory failure.. CT = computer tomography; CXR = chest X-ray; FES = fat embolism syndrome; RV = right ventricle.
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A repeat CXR on hospital day 3 showed diffuse bilateral infiltrates (Fig. 1a and b). A CT angiogram demonstrated an enlarged RV and dilated pulmonary artery (PA) without evidence of thromboembolism (Fig. 1c and d).
TTE in FES.. TTE at presentation to ICU (a/b) and follow up 6 months later (c/d). Note bowing of RV into LV at presentation in apical four chamber view (a) indicating RV pressure overload which had resolved at follow up (c).. Ao = Aorta; AV = aortic valve; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.
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Transthoracic echocardiogram (TTE) showed a hyperdynamic left ventricle (LV), severely dilated RV with depressed systolic function, and an estimated RV systolic pressure of 75 mmHg (Fig. 2a and b). Follow-up TTE demonstrated normal RV size and function without evidence of pulmonary hypertension (Fig. 2c and d).