Pulmonary fat embolism probably occurs commonly after major orthopedic injuries and after orthopedic surgery. Furthermore, tiny fat emboli can often be shown by transesophageal echocardiography during orthopedic surgery. However, large macroscopic are rarely identified radiologically. Macroscopic fat emboli have been previously described in the common femoral vein and inferior vena cava on abdominal imaging. To the authors' knowledge, a macroscopic fat embolus in the pulmonary arteries has not been previously described. The authors report a case of a woman who, on computed tomography, had a large fat embolus after intramedullary rod placement for an isolated left femur fracture.