Fatal
fat embolism is usually thought of as a sequel to long-
bone fracture, although cases secondary to
soft tissue injury and atraumatic conditions have been infrequently reported. In this case of a two-year-old child-abuse victim who sustained multiple blunt traumatic
injuries without skeletal fractures, pulmonary and systemic (brain and kidney) fat emboli were identified. At autopsy, all thoracic and abdominal viscera were intact; cranial contents exhibited only diffuse symmetrical petechial
hemorrhages of the white matter. Because of the severe and widespread nature of soft tissue
hemorrhage, and the absence of a grossly discernible cause of death,
fat embolism was suspected. Using a combination of frozen section with
oil red O staining and
formalin-fixed
osmium stained tissues, the immediate cause of death was determined to be diffuse
fat embolism. Review of the literature reveals a pathophysiologic basis for
fat embolism in the absence of fracture, both as a consequence of an acute increase in local pressure at the site of
trauma and an alteration of the emulsification of blood
lipids during
shock. In light of these findings, we present this case to remind the forensic science community to consider
fat embolism as the cause of death in cases of blunt-force injury without fracture.