Case Report: Paradoxic fat Embolism of Renal Artery Caused by Bone-Needle Resuscitation Leading to Arterial Hypertension and Myocardial Dysfunction

Background: Fat embolism is a phenomenon, occurring mostly in trauma as bone fractures and blunt trauma. The use of bone needles in the emergency medicine led to the development of studies regarding the incidence of fat embolism, which can occur in porcine model in up to 30% of the cases. A single-center postmortem autopsy study in 20 pediatric patients showed fat embolism after the use of bone needles in 8 of 13 cases and none in the group without bone needles. Paradoxic embolism in neonates has been reported in multiple case-reports, but until now there is a lack of controlled studies. Paradoxical embolism can occur due to patent foramen ovale, patent arterial duct or persistent pulmonary hypertension.

Method: We report the case of a 5-day-old newborn deteriorating in the obstetrics unit of a second-level hospital and resuscitated under the use of a intraosseous fluid administration. An initial echocardiographic examination depicted a severe myocardial dysfunction with moderate mitral valve insufficiency. After admittance in the department of pediatric cardiology under suspicion of cardiomyopathy or aortic coarctation a second echocardiographic examination was performed, excluding a congenital heart defect but confirmed the severe myocardial dysfunction. Additionally, a severe arterial hypertension with systolic blood pressures up to 180 mm Hg was diagnosed without a systolic pressure Gradient between upper and lower limb. Therefore, a kidney-ultrasound was performed revealing a stenosis flow-pattern of the right renal artery. After medicated stabilization of the blood pressure and inotropic support with the use of milrinone and urapidil, on 3rd day after admittance an angiographic examination was performed, showing multiple fat embolisms in the right kidney arteries. These have been successfully removed by aspiration embolectomy.

Conclusion: The bone needle is widely spread used as an alternative intravenous access in pediatric patients and emergency medicine. In literature fat lung-embolism is described in up to 62% of patients after the use bone-needle. In the use of bone needle for resuscitation in neonates, paradoxic fat embolism at the level of patent arterial duct and patent foramen ovale and its adverse sequel should be considered.

Publication History

Article published online:
28 January 2023