Pulmonary features:
- respiratory insufficiency occurs in 75% of patients with FES presenting with dyspnoea, tachypnoea, and fine inspiratory crackles 2-3 days after injury. The chest x-ray is often normal initially but bilateral fluffy shadows develop as respiratory insufficiency worsens. Approximately 10% of patients will develop respiratory failure with all the clinical features and attendant mortality of ARDS.
Cerebral features:
- cerebral emboli produce neurological signs in up to 86% of cases. Neurological features often precede pulmonary features by 6-12 hours. Patients often present in an acute confusional state although a subgroup of patients develop focal neurological signs including hemiplegia, aphasia, apraxia, visual field disturbances and anisocoria. Seizures and decorticate posturing have also been seen in FES. Fortunately, almost all neurological deficits are reversible.
Cutaneous features:
- cutaneous features due to embolisation within the dermal capillaries occur in 60% of cases. This produces a petechial rash in the conjunctiva, oral mucous membrane and skin folds of the upper body, especially the neck and axilla. The rash appears within the first 36 hours and is self-limiting, disappearing completely within 7 days.
Minor features include pyrexia, tachycardia, ECG changes indicative of right heart strain, soft fluffy retinal exudates with macular oedema, and renal changes presenting as oliguria, lipuria, proteinuria or haematuria.