Chest
Volume 101, Issue 6, June 1992, Pages 1710-1711
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Selected Reports
Fat Embolism Syndrome and Pulmonary Microvascular Cytology

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Pulmonary microvascular cytology consists of analysis of capillary blood sampled while a Swan-Ganz catheter is in the wedge position. This technique has proved to be useful in the diagnosis of lymphangitic spread of carcinoma in the lungs and there are case reports of their use in amniotic fluid embolism. Its usefulness in diagnosing fat embolism syndrome has been shown only rarely. We report a new case in which pulmonary microvascular cytologic study allowed a definite diagnosis of fat embolism syndrome. We suggest obtaining routinely samples of capillary blood when a pulmonary catheter is in place and fat embolism is suspected on a clinical basis.

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Case Report

A 23-year-old woman was admitted to the hospital after severe trauma from a car accident. At the time of admission she showed normal vital signs except a heart rate of 140 beats/min (bpm); neurologic examination demonstrated a Glasgow coma score of 15. Trauma to both legs was evident, with fractures in right femur, right tibia, and left patella. A diagnostic peritoneal lavage was positive and she was taken to the operating room where two hepatic lacerations were sutured. The patella fracture

Discussion

Pulmonary microvascular cytology is a new technique that samples capillary lung blood obtained from a wedged Swan-Ganz catheter.11 Its usefulness has been shown in diagnosing a few cases of amniotic fluid embolism.11, 12, 13 Despite some discussion,14 Masson et al11, 15 proposed capillary blood sampling as a useful diagnostic procedure in lymphangitic carcinomatosis of the lung and established it showed malignant cells in seven of eight samples from patients with lymphangitic spread of

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