Abstract
Fat embolism syndrome is a rare clinical entity. The diagnosis is largely clinical, with the imaging studies supporting the clinical diagnosis. Here we present the case of a 19-year-old boy who presented with a tibial fracture and developed sudden onset shortness of breath on the following day. His clinical and investigation findings were suggestive of acute respiratory distress syndrome with fever, tachycardia, and tachypnea along with acute hemoglobin and platelet drop with positive fat globules. According to two clinical criteria, his diagnosis of fat embolism was established. The diagnostic dilemma arose when S1Q3T3 was seen in the electrocardiogram raising a doubt whether it could be a pulmonary embolism.