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Fat or Thrombus: You
EP30692
Poster Title: Fat or Thrombus: You'd Better Think Twice About Clogging Up Your Arteries - Utilising CTPA for the Diagnosis of Fat Embolism
Submitted on 27 Sep 2019
Author(s): Dr Gayathri Yogarajah, Dr Joel James, Dr Tom Osborne, Dr Adeeb Alam
Affiliations: Ashford and St Peter's Hospitals NHS Foundation Trust
This poster was presented at BIR Annual Congress 2019
Poster Views: 226
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Poster Information
Abstract: Problem/purpose:
Diagnosing fat embolism is very challenging based on clinical criteria alone. Using imaging as a diagnostic aid with a CT Pulmonary Angiogram (CTPA) and correlating clinical criteria (Gurds criteria) it may be possible to identify which patients originally suspected of having a PE are likely to have suffered a fat embolism. This can potentially alter clinical management in patients at high risk of bleeding by avoiding unnecessary anticoagulation.

Methods:
An ROI Hounsfield Unit range for thrombus (+45 to +100) versus fat (-50 to -150) was used for the purpose of this study.
We collected and analysed the data of pre- and post-operative trauma and orthopaedic patients over a 1 year period who had undergone investigation with CTPA for suspected pulmonary embolism. We reviewed PACS images, reports and patient clinical notes in this study.

Results:
20 out of 126 patients analysed were diagnosed to have filling defects consistent with pulmonary emboli. 5 of those 20 patients in our study were suspected to have suffered a fat embolism using the radiological criteria outlined above (-50 to -150 HU).
1 patient’s findings correlated both clinically (using Gurds Criteria) and radiologically for high suspicion of fat embolus.
4 patients met radiological criteria for fat emboli, however there was insufficient documentation to identify if clinical criteria were met.

Conclusion:
Management of fat emboli differs significantly from that of pulmonary emboli. This could have significant implication in patients at high risk of bleeding by avoiding anticoagulation and subsequent risks associated with this. We should ensure Gurds criteria is implemented in protocol when requesting CTPA for possible PE in Trauma and Orthopaedic patients if fat embolism is suspected to enable combined radiological and clinical correlation for diagnosis.
Summary: The utilisation of CTPA in the diagnosis of fat embolismReport abuse »
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