Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2025, 169(2):116-122 | DOI: 10.5507/bp.2024.014

Fat embolism and COVID-19 infection: autopsy and post-mortem laboratory findings in SARS-CoV-2 positive patients

Adriana Gavronova1, 2, Lukas Hamerlik1, 2, Margita Bartkova3, Vaclav Svrchokryl1, 2, Veronika Kralikova1, 2, Katerina Vranova1, 2, Peter Ondra1, 2, Martin Dobias1, 2
1 Department of Forensic Medicine and Medical Law, University Hospital Olomouc, Olomouc, Czech Republic
2 Department of Forensic Medicine and Medical Law, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
3 Clinical laboratory, Psychiatric Hospital, Sternberk, Czech Republic

Introduction: The article is one of the very first autopsy reports worldwide, which associates COVID-19 infection and pulmonary fat embolism.

Aims: To point to a crucial connection between a severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2) infection and pulmonary fat embolism as one of the possible major mechanisms of severe COVID-19 symptoms.

Methods: Lung, brain and kidney tissues examination of 16 full human autopsy cases. All deceased suffered from COVID-19 infection, none of them was admitted to hospital prior to death, immediate causes of death vary. Autopsies accompanied by microbiological examination and histological examination using Oil Red O staining were performed. Consequently, we have implemented a control cohort consisting of 16 deceased with no presence of pulmonary infection and various immediate causes of death.

Results: Of the 16 autopsy cases, 11 (68.8%) were males and 5 (31.3%) females, with overall mean age 68.1 (39-86) years. Causes of death of studied subjects were natural, mostly from respiratory failure (in 12 cases, 75%). Cardiopulmonary resuscitation was performed in 7 cases (43.8%). None of dissected persons had larger signs of body trauma. Pulmonary fat embolism was found in 11 cases (68.8%), which generalised to kidneys in 8 patients (50% of all cases, 72.3% of cases with pulmonary fat embolism) and to brain tissue in 1 case.

Conclusion: We demonstrated a reasonable relation between a COVID-19 disease and a variously severe fat embolism, severity of which does not directly correlate with body weight. Further investigation or even change of medical treatment needs to be considered in patients with COVID-19.

Keywords: COVID-19, coronavirus, autopsy, post-mortem, fat embolism, FES

Received: March 26, 2024; Revised: April 25, 2024; Accepted: April 30, 2024; Prepublished online: May 28, 2024; Published: June 1, 2025  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Gavronova, A., Hamerlik, L., Bartkova, M., Svrchokryl, V., Kralikova, V., Vranova, K., Ondra, P., & Dobias, M. (2025). Fat embolism and COVID-19 infection: autopsy and post-mortem laboratory findings in SARS-CoV-2 positive patients. Biomedical papers, 169(2), 116-122. doi: 10.5507/bp.2024.014
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. . COVID-19 Weekly Epidemiological Update. In. World Health Organization. 2023. https://reliefweb.int/report/world/covid-19-weekly-epidemiological-update-edition-162-published-22-december-2023. Accessed 22 December 2023
    2. . The Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi 2020;41(2):145-51. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003 (In Chinese) Go to original source... Go to PubMed...
    3. . Cinti S, Graciotti L, Giordano A, Valerio A, Nisoli E. COVID-19 and fat embolism: a hypothesis to explain the severe clinical outcome in people with obesity. Int J Obes (Lond) 2020;44(8):1800-2. doi: 10.1038/s41366-020-0624-5 Go to original source... Go to PubMed...
    4. . Mason JK. Pulmonary Fat and Bone Marrow Embolism as an Indication of Ante-Mortem Violence. Med Sci Law 1968;8(3):200-6. doi: 10.1177/002580246800800311 Go to original source... Go to PubMed...
    5. . Tan YJ, Lim SG, Hong W. Regulation of cell death during infection by the severe acute respiratory syndrome coronavirus and other coronaviruses. Cell Microbiol 2007;9(11):2552-61. doi: 10.1111/j.1462-5822.2007.01034.x Go to original source... Go to PubMed...
    6. . Kong J, Yang T, Zhang F, Liao X, Du S, Yang X, Li D. Pulmonary fat embolism: a potentially new fatal complication of SARS-CoV-2 infection. A case report. BMC Infect Dis 2023;23(1):576. doi: 10.1186/s12879-023-08559-4 Go to original source... Go to PubMed...
    7. . Milroy CM, Parai JL. Fat Embolism, Fat Embolism Syndrome and the Autopsy. Acad Forensic Pathol 2019;9(3-4):136-54. doi: 10.1177/1925362119896351 Go to original source... Go to PubMed...
    8. . Hussain M, Khurram Syed S, Fatima M, Shaukat S, Saadullah M, Alqahtani AM, Alqahtani T, Bin Emran T, Alamri AH, Barkat MQ, Wu X. Acute Respiratory Distress Syndrome and COVID-19: A Literature Review. J Inflamm Res 2021;14:7225-42. doi: 10.2147/JIR.S334043 Go to original source... Go to PubMed...
    9. . International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC). COVID-19 Report: 19 May 2020 [Internet]: ISARIC; 2020. Available from: https://media.tghn.org/medialibrary/2020/05/ISARIC_Data_Platform_COVID-19_Report_19MAY20.pdf.
    10. . Zhang JJY, Lee KS, Ang LW, Leo YS, Young BE. Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis. Clin Infect Dis 2020;71(16):2199-206. doi: 10.1093/cid/ciaa576 Go to original source... Go to PubMed...
    11. . Edler C, Schröder AS, Aepfelbacher M, Fitzek A, Heinemann A, Heinrich F, Klein A, Langenwalder F, Lütgehetmann M, Meißner K, Püschel K, Schädler J, Steurer S, Mushumba H, Sperhake JP. Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany. Int J Legal Med 2020;134(4):1275-84. doi: 10.1007/s00414-020-02317-w. Erratum in: Int J Legal Med 2020;134(5):1977. Go to original source... Go to PubMed...
    12. . Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18(4):844-7. doi: 10.1111/jth.14768. Go to original source... Go to PubMed...
    13. . Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054-62. doi: 10.1016/S0140-6736(20)30566. Erratum in: Lancet 2020;395(10229):1038. Go to original source...
    14. . Rodrigues JCL, Hare SS, Edey A, Devaraj A, Jacob J, Johnstone A, McStay R, Nair A, Robinson G. An update on COVID-19 for the radiologist - A British society of Thoracic Imaging statement. Clin Radiol 2020;75(5):323-5. doi: 10.1016/j.crad.2020.03.003 Go to original source... Go to PubMed...
    15. . Charles M, Barr T, Clokie CM, Sándor GK. Fat embolism following posterior iliac graft harvest for jaw reconstruction: managing the complications of major surgery. J Can Dent Assoc 2007;73(1):67-70.
    16. . Bulger EM, Smith DG, Maier RV, Jurkovich GJ. Fat embolism syndrome. A 10-year review. Arch Surg 1997;132(4):435-9. doi: 10.1001/archsurg.1997.01430280109019 Go to original source... Go to PubMed...
    17. . Glover P, Worthley LI. Fat embolism. Crit Care Resusc 1999;1(3):276-84. Go to original source...
    18. . Saigal R, Mittal M, Kansal A, Singh Y, Kolar PR, Jain S. Fat embolism syndrome. J Assoc Physicians India 2008;56:245-9. Erratum in: J Assoc Physicians India 2008;56:392.
    19. . Kaplan RP, Grant JN, Kaufman AJ. Dermatologic features of the fat embolism syndrome. Cutis 1986;38(1):52-5.
    20. . Apostolou CD, Skourtas CE, Tsifetakis SD, Papagelopoulos PJ. Fat embolism after uncemented total hip arthroplasty. Clin Orthop Relat Res 2002;(398):153-6. doi: 10.1097/00003086-200205000-00022 Go to original source... Go to PubMed...
    21. . Gurd AR. Fat embolism: an aid to diagnosis. J Bone Joint Surg Br 1970;52(4):732-7. Go to original source...
    22. . Shaikh N, Mahmood Z, Ghuori SI, Chanda A, Ganaw A, Zeeshan Q, Ehfeda M, Mohamed Belkhair AO, Zubair M, Kazi ST, Momin U. Correlation of clinical parameters with imaging findings to confirm the diagnosis of fat embolism syndrome. Int J Burns Trauma 2018 20;8(5):135-44.
    23. . Hofmann S, Huemer G, Salzer M. Pathophysiology and management of the fat embolism syndrome. Anaesthesia 1998;53 Suppl 2:35-7. doi: 10.1111/j.1365-2044.1998.tb15146.x Go to original source... Go to PubMed...
    24. . Colleluori G, Graciotti L, Pesaresi M, Di Vincenzo A, Perugini J, Di Mercurio E, Caucci S, Bagnarelli P, Zingaretti CM, Nisoli E, Menzo S, Tagliabracci A, Ladoux A, Dani C, Giordano A, Cinti S. Visceral fat inflammation and fat embolism are associated with lung's lipidic hyaline membranes in subjects with COVID-19. Int J Obes (Lond) 2022;46(5):1009-17. doi: 10.1038/s41366-022-01071-w Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content