Volume 35, Issue 2 (March 1990)

    Case Report: Nonfracture-Associated Fatal Fat Embolism in a Case of Child Abuse

    (Received 24 February 1989; accepted 25 April 1989)

    CODEN: JFSOAD

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    Abstract

    Fatal fat embolism is usually thought of as a sequel to long-bone fracture, although cases secondary to soft tissue injury and atraumatic conditions have been infrequently reported. In this case of a two-year-old child-abuse victim who sustained multiple blunt traumatic injuries without skeletal fractures, pulmonary and systemic (brain and kidney) fat emboli were identified. At autopsy, all thoracic and abdominal viscera were intact; cranial contents exhibited only diffuse symmetrical petechial hemorrhages of the white matter. Because of the severe and widespread nature of soft tissue hemorrhage, and the absence of a grossly discernible cause of death, fat embolism was suspected. Using a combination of frozen section with oil red O staining and formalin-fixed osmium stained tissues, the immediate cause of death was determined to be diffuse fat embolism.

    Review of the literature reveals a pathophysiologic basis for fat embolism in the absence of fracture, both as a consequence of an acute increase in local pressure at the site of trauma and an alteration of the emulsification of blood lipids during shock. In light of these findings, we present this case to remind the forensic science community to consider fat embolism as the cause of death in cases of blunt-force injury without fracture.


    Author Information:

    Davis, GJ
    Chief medical examiner, resident in pathology, and fellow in forensic pathology, Office of the Chief Medical Examiner and Department of Pathology, University of Louisville School of Medicine, Louisville, KY

    Nichols, GR
    Chief medical examiner, resident in pathology, and fellow in forensic pathology, Office of the Chief Medical Examiner and Department of Pathology, University of Louisville School of Medicine, Louisville, KY

    Corey, TS
    Chief medical examiner, resident in pathology, and fellow in forensic pathology, Office of the Chief Medical Examiner and Department of Pathology, University of Louisville School of Medicine, Louisville, KY


    Stock #: JFS12853J

    ISSN: 0022-1198

    DOI: 10.1520/JFS12853J

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    Author
    Title Case Report: Nonfracture-Associated Fatal Fat Embolism in a Case of Child Abuse
    Symposium , 0000-00-00
    Committee E30