Fatal fat embolism after spinal fusion for scoliosis

An adolescent girl who underwent Harrington instrumentation and spinal fusion for idiopathic scoliosis had the adult respiratory distress syndrome develop in the immediate postoperative period. Massive fat embolization to the lungs was present at postmortem examination, an apparently rare complication of this surgical procedure. This case emphasizes the necessity of maintaining a high index of suspicion. In any clinical setting that would place a patient at risk for fat emboli and illustrates the unreliability of many of the clinical and laboratory features frequently described as useful for establishing the diagnosis.