Difference between revisions of "Cholesterol embolism"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Cholesterol embolus - high mag.jpg | ||
| Width = | | Width = | ||
| Caption = Cholesterol embolism. [[H&E stain]]. | | Caption = Cholesterol embolism. [[H&E stain]]. | ||
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| Assdx = [[atherosclerosis]] | | Assdx = [[atherosclerosis]] | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = +/-cardiovascular disease, +/-risk factors for cardiovascular disease (age, [[hypertension]], hypercholesterolemia, [[diabetes mellitus|diabetes]], [[smoking]]) | | Clinicalhx = +/-cardiovascular intervention, +/-cardiovascular disease, +/-risk factors for cardiovascular disease (age, [[hypertension]], hypercholesterolemia, [[diabetes mellitus|diabetes]], [[smoking]]) | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = | ||
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*Significant CEs are often iatrogenic. | *Significant CEs are often iatrogenic. | ||
**Known complication of coronary catherization (incidence ~ 1%).<ref name=pmid12875753>{{cite journal |author=Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A |title=The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study |journal=J. Am. Coll. Cardiol. |volume=42 |issue=2 |pages=211–6 |year=2003 |month=July |pmid=12875753 |doi=10.1016/S0735-1097(03)00579-5 | url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703005795}}</ref> | **Known complication of coronary catherization (incidence ~ 1%).<ref name=pmid12875753>{{cite journal |author=Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A |title=The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study |journal=J. Am. Coll. Cardiol. |volume=42 |issue=2 |pages=211–6 |year=2003 |month=July |pmid=12875753 |doi=10.1016/S0735-1097(03)00579-5 | url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703005795}}</ref> | ||
**May complicate any vascular surgery, CABG. | **May complicate any vascular surgery, [[CABG]]. | ||
==Microscopic== | ==Microscopic== | ||
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Image:Cholesterol_embolus_-_intermed_mag.jpg | Cholesterol embolus - intermed. mag. (WC) | Image:Cholesterol_embolus_-_intermed_mag.jpg | Cholesterol embolus - intermed. mag. (WC) | ||
Image:Cholesterol_embolus_-_high_mag.jpg | Cholesterol embolus - high mag. (WC) | Image:Cholesterol_embolus_-_high_mag.jpg | Cholesterol embolus - high mag. (WC) | ||
Image: Cholesterol embolus - very high mag.jpg | Cholesterol embolus - very high mag. (WC) | |||
</gallery> | </gallery> | ||
Latest revision as of 17:23, 18 June 2014
| Cholesterol embolism | |
|---|---|
| Diagnosis in short | |
 Cholesterol embolism. H&E stain. | |
|
| |
| LM | intravascular cholesterol clefts (biconvex white spaces), +/-macrophages and giant cells, +/-eosinophils |
| Site | blood vessels - arteries |
|
| |
| Associated Dx | atherosclerosis |
| Clinical history | +/-cardiovascular intervention, +/-cardiovascular disease, +/-risk factors for cardiovascular disease (age, hypertension, hypercholesterolemia, diabetes, smoking) |
| Prevalence | not typically biopsied, common in eldery |
| Prognosis | dependent on extent |
| Clin. DDx | vasculitis |
Cholesterol embolism, abbreviated CE, is characterized by intravascular cholesterol.
Cholesterol embolus (plural cholesterol emboli) and cholesterol embolization redirect here.
General
- Strong association with atherosclerosis - found in ~3% of individuals in an autopsy series of 267 older individuals (mean age ~65 years).[1]
- Significant CEs are often iatrogenic.
Microscopic
Features:[3]
- Intravascular cholesterol clefts (biconvex white spaces) - key feature.
- Typically ~ 100-500 micrometers (long axis) x 50-100 micrometers (short axis). (?)
- +/-Macrophages and giant cells.
- +/-Eosinophils.
Note:
- May be associated with ischemic changes and necrosis.
- Usually in the context of severe atherosclerosis.
Note (trivia):
- Cholesterol crystals dissolve with routine processing (paraffin embedding); this is why one talks of "cholesterol clefts".
Images
Cholesterol embolus - intermed. mag. (WC)
Cholesterol embolus - high mag. (WC)
Cholesterol embolus - very high mag. (WC)
See also
References
- ↑ Flory CM (1945). "Arterial occlusions produced by emboli from eroded aortic atheromatous plaques". Am J Pathol 21 (3): 549–565. PMC 1934118. PMID 19970827. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1934118/.
- ↑ Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A (July 2003). "The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study". J. Am. Coll. Cardiol. 42 (2): 211–6. doi:10.1016/S0735-1097(03)00579-5. PMID 12875753. http://linkinghub.elsevier.com/retrieve/pii/S0735109703005795.
- ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Reuter, Victor E; Stoler, Mark H (2009). Sternberg's Diagnostic Surgical Pathology (5th ed.). Lippincott Williams & Wilkins. pp. 1735-6. ISBN 978-0781779425.