多发性创伤患者股骨干骨折的CT可见静脉脂肪栓塞：病例报告
CT-Visible Venous Fat Embolus Associated With a Femoral Shaft Fracture in a Polytrauma Patient: A Case Report.
摘要(中文译文)
静脉脂肪栓塞在长骨骨折患者中并不常见，但却是重要的影像学发现，而CT直接显示者鲜有报道。我们报告一例34岁男性多发伤患者，据报血流动力学稳定，因摩托车交通事故入院。初始X线片显示左股骨干近端三分之一完全性移位骨折。全身创伤CT显示左髂外静脉远端内有一脂肪衰减的血管内病灶，并延伸至左股总静脉近端，衰减值约为-81亨氏单位，符合静脉脂肪栓塞。该病灶在可获得的平扫、动脉期和门静脉期图像上均持续存在于同一静脉位置。胸部CT血管造影在可获得的图像上未见肺动脉充盈缺损或急性肺实质异常。腹盆腔CT还显示脾上极裂伤，深度超过3 cm，伴有脾周腹腔积血，符合美国创伤外科协会分级III级脾损伤。在可获得的动脉期、门静脉期和延迟期图像上未见明确的对比剂活动性外溢。随后对股骨骨折进行了骨科固定；然而，可获得的病历中未记录详细的随访数据，包括呼吸系统演变、神经系统状态、实验室数据、脾损伤处理及出院结局。本病例强调了在长骨骨折患者的全身创伤CT上进行系统性静脉评估的重要性，并强调应区分CT可见的静脉脂肪栓塞与脂肪栓塞综合征，后者仍是一种需要适当临床关联的临床诊断。
Abstract
Venous fat emboli are uncommon but important radiological findings in patients with long-bone fractures, and direct visualization on computed tomography (CT) is rarely reported. We report the case of a 34-year-old man with polytrauma, reported to be hemodynamically stable, admitted after a motorcycle road traffic accident. Initial radiography demonstrated a complete, displaced fracture of the proximal third of the left femoral shaft. Whole-body trauma CT revealed a fat-attenuation intravascular lesion within the distal left external iliac vein extending into the proximal left common femoral vein, with an attenuation value of approximately -81 Hounsfield units, consistent with a venous fat embolus. The lesion persisted in the same venous location across the available non-contrast, arterial-phase, and portal venous-phase images. Thoracic CT angiography showed no pulmonary arterial filling defect or acute pulmonary parenchymal abnormality on the available images. Abdominopelvic CT also demonstrated a superior polar splenic laceration measuring more than 3 cm in depth, associated with perisplenic hemoperitoneum, consistent with grade III splenic injury according to the American Association for the Surgery of Trauma classification. No definite active contrast extravasation was identified on the available arterial, portal venous, and delayed-phase images. Orthopedic fixation of the femoral fracture was subsequently performed; however, detailed follow-up data, including respiratory evolution, neurological status, laboratory data, splenic injury management, and discharge outcome, were not documented in the available medical record. This case highlights the importance of systematic venous assessment on whole-body trauma CT in patients with long-bone fractures and emphasizes the distinction between a CT-visible venous fat embolus and fat embolism syndrome, which remains a clinical diagnosis requiring appropriate clinical correlation.
如何引用
AMA
El Mahdi Choukri, Ali Meqor, Jalal El Kidari, Asmae Oulad Amar, Siham Alaoui Rachidi. CT-Visible Venous Fat Embolus Associated With a Femoral Shaft Fracture in a Polytrauma Patient: A Case Report.. Cureus. 2026; doi:10.7759/cureus.109475.
APA
El Mahdi Choukri, Ali Meqor, Jalal El Kidari, Asmae Oulad Amar, Siham Alaoui Rachidi (2026). CT-Visible Venous Fat Embolus Associated With a Femoral Shaft Fracture in a Polytrauma Patient: A Case Report.. Cureus. https://doi.org/10.7759/cureus.109475
GB/T 7714
El Mahdi Choukri, Ali Meqor, Jalal El Kidari, Asmae Oulad Amar, Siham Alaoui Rachidi. CT-Visible Venous Fat Embolus Associated With a Femoral Shaft Fracture in a Polytrauma Patient: A Case Report.[J]. Cureus, 2026 doi:10.7759/cureus.109475.
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