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Difference between revisions of "Cholesterol embolism"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Cholesterol embolus - high mag.jpg | |||
| Width = | |||
| Caption = Cholesterol embolism. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = intravascular cholesterol clefts (biconvex white spaces), +/-macrophages and giant cells, +/-eosinophils | |||
| Subtypes = | |||
| LMDDx = | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[blood vessels]] - arteries | |||
| Assdx = [[atherosclerosis]] | |||
| Syndromes = | |||
| Clinicalhx = +/-cardiovascular intervention, +/-cardiovascular disease, +/-risk factors for cardiovascular disease (age, [[hypertension]], hypercholesterolemia, [[diabetes mellitus|diabetes]], [[smoking]]) | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = not typically biopsied, common in eldery | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = dependent on extent | |||
| Other = | |||
| ClinDDx = [[vasculitis]] | |||
| Tx = | |||
}} | |||
'''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).<ref name=pmid19970827>{{cite journal | author=Flory CM | title=Arterial occlusions produced by emboli from eroded aortic atheromatous plaques | journal=Am J Pathol | year= 1945 | volume=21 | pages=549–565 | pmid=19970827 | issue=3 | pmc=1934118}}</ref> | |||
*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> | |||
**May complicate any vascular surgery, [[CABG]]. | |||
==Microscopic== | |||
Features:<ref name=Ref_Sternberg5_1735-6>{{Ref Sternberg5|1735-6}}</ref> | |||
*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=== | |||
<gallery> | |||
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 - very high mag.jpg | Cholesterol embolus - very high mag. (WC) | |||
</gallery> | |||
==See also== | |||
*[[Vascular disease]]. | |||
*[[Atherosclerosis]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Cardiovascular pathology]] | |||