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Macroscopic Pulmonary Fat Embolism Secondary to Intraosseous Line Placement: A Case Report
Stephanie J Chen1, Andrew C Sanchez2, Serena T Hua3
1Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, California, USA, stanford.edu.
Case Reports in Critical Care
|June 11, 2026
Summary
Intraosseous access can rarely cause pulmonary fat embolism, a serious complication. This case highlights the need for awareness and suggests aspiration thrombectomy may help in severe macroscopic cases.
Area of Science:
- Emergency Medicine
- Critical Care Medicine
- Cardiovascular Medicine
Background:
- Intraosseous (IO) access is a common emergency vascular access method.
- It is generally considered safe with minimal complications.
- This report details a rare, severe complication of IO access.
Purpose of the Study:
- To report the first case of clinically significant macroscopic pulmonary fat embolism secondary to intraosseous access.
- To raise awareness of this rare but potentially fatal complication.
- To discuss potential therapeutic interventions.
Main Methods:
- A case presentation of a 67-year-old woman who received intraosseous access.
- Cardiopulmonary support with venoarterial extracorporeal membrane oxygenation and Impella.
- Computed tomography (CT) imaging to diagnose pulmonary fat embolism.
- Aspiration thrombectomy procedure.
Main Results:
- The patient developed profound hypotension and biventricular dysfunction post-IO access.
- CT confirmed new macroscopic pulmonary fat embolism.
- Successful aspiration thrombectomy led to hemodynamic improvement.
- The patient unfortunately suffered an anoxic brain injury and was transitioned to comfort care.
Conclusions:
- Intraosseous access, while common, carries a risk of rare but serious pulmonary fat embolism.
- Awareness of this complication is crucial for emergency care providers.
- Supportive care is standard, but aspiration thrombectomy may be beneficial in macroscopic cases.
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