case_images: PMC6317091_01
case_images: Right Femur X-Ray showing acute femur fracture (black arrow).
case_images: CRINM2018-5057624.001.jpg
case_images: PMC6317091_01_CRINM2018-5057624.001.jpg
case_images: fig1
case_images: A 56-year-old male with a history of hypothyroidism and hyperlipidemia was admitted to the hospital after a motor vehicle accident where he sustained a closed right subtrochanteric femur fracture with 4 cm of foreshortening [Figure 1].
case_images: Brain MRI revealed multiple bilateral acute cerebral infarcts (black arrows) with restricted diffusion areas in a "starfield" pattern favoring fat emboli.
case_images: CRINM2018-5057624.002.jpg
case_images: PMC6317091_01_CRINM2018-5057624.002.jpg
case_images: fig2
case_images: Magnetic resonance imaging (MRI) of the brain revealed multiple bilateral acute cerebral infarcts with restricted diffusion areas in a "starfield" pattern favoring the diagnosis of cerebral fat embolism [Figure 2].
case_images: CXR showed diffuse bilateral infiltrates in a "snowstorm" pattern.
case_images: CRINM2018-5057624.003.jpg
case_images: PMC6317091_01_CRINM2018-5057624.003.jpg
case_images: fig3
case_images: Within the first 48 hours of ICU admission he developed a bilateral patchy opacity in a "snowstorm" pattern on chest X-Ray [Figure 3] and his BNP (brain natriuretic peptide) was 24 (normal 0-100 pg/mL).
case_images: Anterior chest wall petechial rash (black arrows).
case_images: CRINM2018-5057624.004.jpg
case_images: PMC6317091_01_CRINM2018-5057624.004.jpg
case_images: fig4
case_images: There was a petechial rash noted on his anterior chest [Figure 4].
case_images: Transesophageal echocardiogram showing significant R to L shunt (white arrow).
case_images: CRINM2018-5057624.005.jpg
case_images: PMC6317091_01_CRINM2018-5057624.005.jpg
case_images: fig5
case_images: Further workup demonstrated a patent foramen ovale (PFO) with a significant right to left shunt [Figure 5] by transesophageal echocardiogram (TEE).
case_images: White arrow showing 3 bubbles crossing the atrial septum on transesophageal echocardiogram.
case_images: CRINM2018-5057624.006.jpg
case_images: PMC6317091_01_CRINM2018-5057624.006.jpg
case_images: fig6
case_images: There was also a positive bubble study [Figure 6].