Cholesterol embolism

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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.


  • 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.
    • Known complication of coronary catherization (incidence ~ 1%).[2]
    • May complicate any vascular surgery, CABG.



  • 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.


  • 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".


See also


  1. Flory CM (1945). "Arterial occlusions produced by emboli from eroded aortic atheromatous plaques". Am J Pathol 21 (3): 549–565. PMC 1934118. PMID 19970827. //
  2. 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.
  3. 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.