Fat embolism syndrome with patent foramen ovale combined with brain fat embolism and lung fat embolism: A case report.

RATIONALE: Fat embolism syndrome is a rare complication of fractures or orthopedic surgeries, and cases combined with patent foramen ovale (PFO), cerebral fat embolism, and pulmonary fat embolism are extremely rare.

PATIENT CONCERNS: A 65-year-old female developed sudden shortness of breath and disturbed consciousness 1 day after hip replacement surgery for a left femoral neck fracture, which was misdiagnosed as an acute cerebral infarction.

DIAGNOSES: Taking into account the patient's history of trauma and surgery, cranial diffusion-weighted imaging revealed typical changes indicative of the "3-territory sign"; transthoracic echocardiography confirmed the presence of a PFO; and the transcranial Doppler bubble test detected signals of fat embolism. The patient was ultimately diagnosed with cerebral fat embolism, pulmonary fat embolism, and a PFO.

INTERVENTIONS: The patient received treatments such as hormone therapy, anticoagulation, and fluid replacement.

OUTCOMES: Following the treatment, the patient gradually regained consciousness, with respiratory failure corrected and neurological function restored to normal. A follow-up cranial diffusion-weighted imaging scan revealed a marked reduction in the lesions.

LESSONS: For high-risk patients with long bone fractures or multiple traumas, close monitoring of vital signs is essential. When shock or neurological changes occur, fat embolism syndrome should be highly suspected. Early fluid resuscitation, timely cranial magnetic resonance imaging examination, and evaluation of pathological shunts (such as PFO) are crucial for improving prognosis.