Rare, Fatal Pulmonary Fat Embolism after Acupuncture Therapy: A Case Report and Literature Review

Background: In the clinic, death from nontraumatic pulmonary fat embolism associated with minor soft tissue contusion, surgery, cancer chemotherapy, hematologic disorders and so on has been reported. Patients often present with atypical manifestations and rapid deterioration, making diagnosis and treatment difficult. However, there are no reported cases of death from pulmonary fat embolism after acupuncture therapy. This case aims to emphasize that awareness of nontraumatic pulmonary fat embolism as a complication of acupuncture therapy needs to be improved. In addition, it suggests that in such cases, autopsy should be used to identify the source of fat emboli. Case presentation: The patient, a 72-year-old woman, experienced symptoms of dizziness and fatigue after silver-needle acupuncture therapy. She experienced a significant drop in blood pressure and died 2 hours later despite treatment and resuscitation. A systematic autopsy and histopathology examination (H&E and Sudan Ⅲ staining) were performed. More than 30 pinholes were observed on the surface of the lower back. Focal hemorrhages were seen surrounding the pinholes in the subcutaneous fatty tissue. Microscopically, numerous fat emboli were observed in the interstitial pulmonary artery and a large number of alveolar wall capillaries, in addition to the vessels of the heart, liver, spleen and thyroid gland. The lungs showed congestion and edema. However, the cause of death was identified as pulmonary fat embolism. Conclusion: This article suggests that high vigilance for risk factors and the complication of pulmonary fat embolism following silver-needle acupuncture therapy should be exercised. In postmortem examinations, examining the peripheral arterial system and the venous system draining from noninjured sites for the formation of fat emboli is helpful to differentiate posttraumatic and nontraumatic pulmonary fat embolism.

Iatrogenic pulmonary fat embolism after surgery in a patient with fatty liver

Introduction. Fat embolism refers to the presence of fat globules in the lung parenchyma and its peripheral circulation. Obstruction of the lung vessels by fat emboli can lead to acute cor pulmonale when the compensatory capabilities of the pulmonary vasculature are exceeded. Case report. We presented a case of a 78-year old man who suffered a dissection of abdominal aortic aneurysm. Urgent surgical procedure was performed and aneurysm replaced with aortobifemoral bypass grafting using a Dacron graft. Despite the procedure the patient died the following day. The autopsy revealed that the cause of death was hypovolemic shock. There were no bone fractures (also no fractures of ribs and sternum from cardiopulmonary resuscitation) or injuries of the subcutaneous fat tissue or other organs (besides those from the surgery). However, additional autopsy findings included fatty liver change, small liver hemorrhages (confirmed microscopically), as well as a presence of fat droplets in the hepatic veins, as well as in the pulmonary vessels, i.e. pulmonary fat embolism [confirmed with hematoxylin/ eosin (H/E), and Sudan III staining], which could be the contributing cause of death. Conclusion. The presented case indicates that pulmonary (or even systemic) fat embolism should be considered as the possible iatrogenic cause of unexpected and unexplained death in the cases where elective surgical procedures were performed in patients with fatty liver change. Pathologists must be aware of this possibility, since it is not easily recognized on routine H/E staining, and some of the special staining technique should be applied.