Twelve hours after intramedullary nailing of a femoral shaft fracture, a 24-year-old man develops confusion, tachypnoea, and a petechial rash over the chest and axillae. Arterial blood gas shows hypoxaemia. The most likely diagnosis is:

• A Pulmonary thromboembolism
• B Anaphylaxis to cement
• C Transfusion-related acute lung injury
• D Fat embolism syndrome ✓

Explanation

Fat embolism syndrome classically presents 12 to 72 hours after long bone fracture or its instrumentation with the Gurd triad: respiratory distress, cerebral involvement, and petechial rash over the chest, axillae, and conjunctivae. Hypoxaemia from pulmonary fat microemboli supports the diagnosis. Pulmonary embolism typically lacks the petechial rash and delayed cerebral signs, and TRALI occurs within 6 hours of transfusion rather than being tied temporally to the fracture.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.