Cholesterol embolism

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).
• Significant CEs are often iatrogenic.
  • Known complication of coronary catherization (incidence ~ 1%).
  • May complicate any vascular surgery, CABG.

Microscopic

Features:

• 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

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  Cholesterol embolus - intermed. mag. (WC)

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  Cholesterol embolus - high mag. (WC)

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  Cholesterol embolus - very high mag. (WC)

See also

• Vascular disease.
• Atherosclerosis.