A 32-year-old man is involved in a vehicular accident and sustains fractures of the right femur and tibia and the left humerus. The fractures are stabilized surgically. He is in stable condition for 2 days, but then suddenly becomes severely dyspneic. Which of the following complications from his injuries is the most likely cause of his sudden respiratory difficulty?

The mechanism for fat embolism is unknown, in particular, why onset of symptoms is delayed 1 to 3 days after the initial injury (or up to 1 week for cerebral symptoms). The cumulative effect of many small fat globules filling peripheral pulmonary arteries is the same as one large pulmonary thromboembolus. Cardiac tamponade and hemothorax would be immediate complications after traumatic injury, not delayed events. Pulmonary edema severe enough to cause dyspnea would be unlikely to occur in hospitalized patients because fluid status is closely monitored. Pulmonary infarction may cause dyspnea, but pulmonary thromboembolus from deep venous thrombosis is typically a complication of a longer hospitalization.