[Cholesterol embolism: a diagnostic puzzle and a therapeutic dilemma].

A well documented and histologically proven case of cholesterol embolism is discussed, and the recent literature is reviewed. This disorder is usually underdiagnosed and commonly detected only at autopsy. Elderly people with atherosclerotic vascular disease are predominantly affected.

An institutional experience with arterial atheroembolism.

Seemingly minor blue-toe lesions resulting from atheroemboli are associated with unstable atherosclerotic plaques, which are at risk for causing recurrent emboli, tissue loss, and potentially death. At Washington University Medical Center, 62 patients (31 males and 31 females), ranging in age from 38 to 89 years (mean 62.8 +/- 11.

[Cholesterol embolism].

Two patients with advanced atherosclerotic vascular disease developed multiple cholesterol emboli. In both patients the clinical presentation included livedo reticularis of the lower part of the body and purple toes with small areas of distal necrosis and ulceration. The predisposing factors are operative vascular procedures and the use of anticoagulants respectively.

Myositis due to cholesterol emboli.

Myositis due to spontaneous cholesterol embolization is uncommon and usually associated with cutaneous abnormalities at presentation. A case of myositis due to cholesterol emboli is reported. The patient presented with painful weak legs, and the diagnosis was confirmed by muscle biopsy.

Position dependent livedo reticularis in cholesterol emboli syndrome.

We describe a case of a 64-year-old Filipino man who presented with cholesterol emboli syndrome manifesting as worsening hypertension, renal failure and livedo reticularis involving the upper legs and lower abdomen. The livedo reticularis became very prominent with the patient standing, but completely vanished after several minutes of lying supine. Deep cutaneous biopsy of an area of skin that was found to be consistently involved with livedo reticularis demonstrated cholesterol clefts in several vessels, thus establishing the diagnosis in this patient, and avoiding the more problematic option of biopsying an involved visceral organ.

[A cholesterol embolism during heparin treatment].

The cholesterol embolization is a rare complication of atherosclerosis. A direct implication of the treatment with anticoagulants in the etiology of the disease has been questioned, and now such therapy is considered more as an adjuvant factor with angiographic procedures than as a cause. A 60-year-old patient with an ischemic cardiomyopathy presented cholesterol embolization syndrome, confirmed by cutaneous biopsy histologic examination during treatment with heparin.

Pleural effusion in patients with systemic cholesterol embolization.

We evaluated two patients with systemic cholesterol embolization (SCE) associated with the development of pleural effusions. These two patients had evidence of atherosclerosis and presented with livedo reticularis, renal insufficiency, and gangrenous cutaneous changes as manifestations of their SCE. In both cases, closed pleural biopsies demonstrated acute inflammation of the parietal pleura.

[Livedo racemosa, skin necrosis at the basal toe joint].

An 81 year old male patient treated by sulfonylurea and diet was known to have type II diabetes for three years. Because of pulmonary embolism phenprocoumon had been administered for four months. Painful livedo racemosa developed acutely on both lateral sides of the feet and the left knee.

Intractable leg ulceration caused by cutaneous cholesterol embolism.

Objective: To present a case of chronic intractable leg ulceration caused by cholesterol crystal embolism.

Clinical Features: A 76-year-old Caucasian male with a history of ischaemic heart disease had repeated hospital admissions for diagnosis and treatment of recurrent leg ulceration of more than three years' duration.

Intervention And Outcome: Definitive diagnosis was made after the third biopsy when the specimen obtained included subcutaneous arteries.

[An often ignored complication of left heart catheterization: embolism of cholesterol crystals. Report of 9 cases].

Cholesterol embolism (CE) is caused by the migration of cholesterol crystals from severe atheromatous lesions. Until recently, this was considered to be a classical but rare complication of atheroma. With the upsurge in techniques of left heart catheterization there has been a regain of interest in this subject.

Cholesterol emboli syndrome following cardiac catheterization.

Cholesterol emboli syndrome should always be considered in an elderly patient with acute renal failure or cutaneous lesions following an invasive vascular procedure or surgery. Laboratory findings that suggest atheroemboli include eosinophilia, an elevated erythrocyte sedimentation rate, leukocytosis, and anemia. Diagnosis is made by biopsy of the affected organ, and treatment is supportive.

[Pampiniform livedo--an acute cardinal symptom of a cutaneous cholesterol embolism].

Acute, painful, persisting, pampiniform and asymmetrical skin discolorations over the legs occurred after retrograde femoral artery catheterization in three patients suspected of having renal artery stenosis. The cause was found histologically to be embolization of cholesterol crystals to the arterioles of the corium-subcutis. Under treatment with acetylsalicylic acid the painful cutaneous changes gradually regressed.

Management of multiple cholesterol embolization syndrome--a case report.

A sixty-two-year-old man who underwent coronary angiography and received acute thrombolytic and anticoagulant therapy for acute myocardial infarction developed multisystemic injury, including renal insufficiency and cutaneous manifestations. Fundoscopic examination and skin biopsy specimen led to the diagnosis of multiple cholesterol embolization syndrome (MCES). Discontinuation of anticoagulants and administration of hemostatic (carbazochrome, tranexamic acid, reptilase, and vitamin K) and antihyperlipidemic (cholestyramine and probucol) drugs resulted in temporary improvement of cutaneous and renal disorders and extended survival for about one year.

Cholesterol crystal embolization: a review of 221 cases in the English literature.

Cholesterol crystal embolization (CCE) frequently presents with nonspecific manifestations that mimic other systemic diseases. The authors reviewed 221 cases of histologically proven CCE in the English literature to define the clinical, laboratory, and pathologic characteristics of this disorder. CCE affected predominantly elderly males (mean age sixty-six) with a frequent history of hypertension (61%), atherosclerotic cardiovascular disease (44%), renal failure (34%), and aortic aneurysms (25%) at presentation.

Disseminated atheroembolism from extensive degenerative atherosclerosis of the aorta.

The surgical management of disseminated atheroembolism was studied in seven patients. The diagnosis of disseminated atheroembolism from extensive degeneration of the thoracic and abdominal aorta was based on clinical evidence of cutaneous atheroembolism, angiographic demonstration of irregular aortic plaques, and findings of cholesterol emboli in tissue specimens. All patients had severe cardiopulmonary disease.

[Symptomatic livedo racemosa in cholesterol embolism with occlusion of the arterioles in the area of the corium-subcutis].

We report on a 70-year-old woman suffering from diabetes mellitus dependent on insulin and associated with malignant hypertension. Following heart catheter examination for the dilatation of the renal arteries, she developed acute, painful, persistent livedo racemosa of the buttocks and the lower extremities. Histological investigation revealed embolism of cholesterol crystals in arterioles of the corium-subcutis region.

The cutaneous manifestations of cholesterol crystal embolization.

In an effort to provide a greater understanding of the cutaneous features of cholesterol crystal embolization (CCE), we reviewed the clinical features of all histologically proved cases reported in the English-language literature, exclusive of cases in which there was only central nervous system or cardiac involvement. We found that the skin is involved in 35% of patients with CCE. Livedo reticularis is the most common skin manifestation (49%), followed by gangrene (35%), cyanosis (28%), ulceration (17%), nodules (10%), and purpura (9%).

Cutaneous cholesterol emboli with infarction clinically mimicking heparin necrosis--a case report.

Cutaneous necrosis secondary to anticoagulation (heparin and warfarin) and cholesterol (atheromatous) emboli can be similar clinically and histologically. A unique case is reported of cholesterol emboli clinically mimicking heparin necrosis. The patient was a 57 year old white male who underwent coronary angioplasty and was treated with intravenous heparin.

Livedo reticularis due to multiple cholesterol emboli.

Three patients with advanced atherosclerotic vascular disease developed multiple cholesterol emboli. The clinical presentation typically includes livedo reticularis of the lower part of the body and purple toes. Small areas of necrosis and ulceration may be present distally, despite palpable pulses.

[Retinal, muscular and cutaneous cholesterol emboli. Progressive encephalopathy].

A 73 year-old man experienced left monocular blindness and transient right hand clumsiness. A left carotid arteriogram was performed 4 days after admission. Immediately following arteriography, there was a right hemiparesia and dysphasia.

Cholesterol embolism as a complication of left heart catheterisation. Report of seven cases.

Cholesterol embolism after left heart catheterisation by the femoral approach was diagnosed in seven men (mean age 59.6 years) out of a total of 4587 catheterisations. Diabetes was present in four patients, systemic hypertension in three, and signs of extensive atherosclerosis in six; five patients were taking anticoagulant drugs.

[Cholesterol embolisms. The anatomical, clinical and pathogenetic aspects. Two case reports, including one case of pseudo periarteritis nodosa (author's transl)].

The authors report on two cases of cholesterol embolism, with one masquerading as polyarteritis nodosa. Cholesterol embolism is a frequent but often unrecognized complication of ulcerous athero-sclerosis. Atherosclerotic foci release a large quantity of cholesterol crystals, spontaneously or after endovascular manipulations, inducing the obstruction of small arteries, 150 to 200 microns in diameter, in various organ or tissues of the organism, such as the kidneys, the spleen, the pancreas, the digestive tract, the skin and the retina.

[Association of disseminated intravascular coagulation and cutaneous crystal cholesterol emboli (author's transl)].

The case of a 72-year-old man with cutaneous cholesterol emboli in association with disseminated intravascular coagulation (D.I.C.