Fat Embolism Syndrome Pancreatitis — FRCA Final MCQ

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HardIntensive Care MedicineFat Embolism Syndrome PancreatitisFRCA Final

A 50-year-old woman in the ICU with necrotising pancreatitis develops sudden onset hypoxia, tachycardia, and petechial rash on the chest and axillae 48 hours after admission. CT chest shows bilateral ground-glass opacities. No PE on CTPA. What is the most likely diagnosis?

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Correct answer: A — Transfusion-related acute lung injury

The triad of respiratory failure (hypoxia, bilateral ground-glass opacities), neurological dysfunction, and petechial rash occurring 24-72 hours after acute pancreatitis suggests fat embolism syndrome (FES). Although classically associated with long bone fractures, FES can occur in pancreatitis (pancreatic lipase liberates free fatty acids that damage the pulmonary capillary endothelium). The petechial rash (chest, axillae, conjunctivae) is pathognomonic but only present in 50-60% of cases. No PE on CTPA excludes thromboembolism. Treatment is supportive: lung-protective ventilation, PEEP, fluid management.

Reference: RCOA – 2023 – ICM curriculum: fat embolism; BTS – 2023 – ARDS management