Autopsy and Case Reports
http://autopsyandcasereports.org/article/doi/10.4322/acr.2018.082
Autopsy and Case Reports
Article / Clinical Case Report

Cholesterol crystal embolism to the gastrointestinal tract: a catastrophic case

Miao Tian; Karen E Matsukuma

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Abstract

Cholesterol crystal embolism is a rare and easily overlooked cause of colonic ischemia. The gastrointestinal tract is the third most common organ system affected by cholesterol emboli, second only to kidney and skin. Here we present a catastrophic case of gastrointestinal cholesterol crystal embolism leading to extensive post-operative bowel infarction and ultimately death. For a practicing pathologist, careful attention to the vessels of any ischemic bowel and recognition of the subtle but distinct angular imprint of cholesterol crystals facilitates prompt identification of the atheroemboli. In some cases, early identification may help mitigate further tissue damage. In more acute and severe cases, identification of the cholesterol crystal emboli may be important primarily for documentation of procedural complications.

Keywords

Cholesterol, Embolism, Gastrointestinal Tract, Ischemia

References

Flory CM. Arterial occlusions produced by emboli from eroded aortic atheromatous plaques. Am J Pathol. 1945;21(3):549-65.19970827

Kassirer JP. Atheroembolic renal disease. N Engl J Med. 1969;280(15):812-8. 10.1056/NEJM196904102801506.4887250

Eliot RS, Kanjuh VI, Edwards JE. Atheromatous embolism. Circulation. 1964;30(4):611-8. 10.1161/01.CIR.30.4.611.14211824

Saric M, Kronzon I. Aortic atherosclerosis and embolic events. Curr Cardiol Rep. 2012;14(3):342-9. 10.1007/s11886-012-0261-2.22437371

Ben-Horin S, Bardan E, Barshack I, Zaks N, Livneh A. Cholesterol crystal embolization to the digestive system: characterization of a common, yet overlooked presentation of atheroembolism. Am J Gastroenterol. 2003;98(7):1471-9. 10.1111/j.1572-0241.2003.07532.x.12873565

Moolenaar W, Lamers CB. Cholesterol crystal embolization in the Netherlands. Arch Intern Med. 1996;156(6):653-7. 10.1001/archinte.1996.00440060081009.8629877

Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A. The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am Coll Cardiol. 2003;42(2):211-6. 10.1016/S0735-1097(03)00579-5.12875753

Fries C, Roos M, Gaspert A, et al. Atheroembolic disease: a frequently missed diagnosis: results of a 12-year matched-pair autopsy study. Medicine. 2010;89(2):126-32. 10.1097/MD.0b013e3181d5eb39.20517183

Moolenaar W, Lamers CB. Cholesterol crystal embolisation to the alimentary tract. Gut. 1996;38(2):196-200. 10.1136/gut.38.2.196.8801196

Konstantinidis IT, Warshaw AL, Deshpande V, et al. Cholesterol crystal embolization presenting as either solid or cystic pancreatic lesion. J Surg Oncol. 2010;102(6):706-8. 10.1002/jso.21521.20976733

Moolenaar W, Lamers CB. Cholesterol crystal embolization to liver, gallbladder, and pancreas. Dig Dis Sci. 1996;41(9):1819-22. 10.1007/BF02088752.8794801

Moolenaar W, Lamers CB. Cholesterol crystal embolization and the digestive system. Scand J Gastroenterol Suppl. 1991;188(Suppl 188):69-72. 10.3109/00365529109111232.1775943

Belenfant X, Meyrier A, Jacquot C. Supportive treatment improves survival in multivisceral cholesterol crystal embolism. Am J Kidney Dis. 1999;33(5):840-50. 10.1016/S0272-6386(99)70415-4.10213638

Ghanem F, Vodnala D, K Kalavakunta J, et al. Cholesterol crystal embolization following plaque rupture: a systemic disease with unusual features. J Biomed Res. 2017;31(2):82-94.28808190

Imanaka K, Kyo S, Ban S. Possible close relationship between non-occlusive mesenteric ischemia and cholesterol crystal embolism after cardiovascular surgery. Eur J Cardiothorac Surg. 2002;22(6):1032-4. 10.1016/S1010-7940(02)00590-0.12467838

Bruls S, Quaniers J, Tromme P, Lavigne JP, Van Damme H, Defraigne JO. Comparison of laparoscopic and open aortobifemoral bypass in the treatment of aortoiliac disease: results of a contemporary series (2003-2009). Acta Chir Belg. 2012;112(1):51-8. 10.1080/00015458.2012.11680795.22442910

Yantiss RK, Cui I, Panarelli NC, Jessurun J. Idiopathic myointimal hyperplasia of mesenteric veins: an uncommon cause of ischemic colitis with distinct mucosal features. Am J Surg Pathol. 2017;41(12):1657-65. 10.1097/PAS.0000000000000905.28817406

Louie CY, DiMaio MA, Charville GW, Berry GJ, Longacre TA. Gastrointestinal Tract Vasculopathy: Clinicopathology and Description of a Possible “New Entity” With Protean Features. Am J Surg Pathol. 2018;42(7):866-76. 10.1097/PAS.0000000000001060.29624512

Tunick PA, Kronzon I. Atheromas of the thoracic aorta: clinical and therapeutic update. J Am Coll Cardiol. 2000;35(3):545-54. 10.1016/S0735-1097(99)00604-X.10716454

Quinones A, Saric M. The cholesterol emboli syndrome in atherosclerosis. Curr Atheroscler Rep. 2013;15(4):315. 10.1007/s11883-013-0315-y.23423524

 

 

 


Publication date:
04/05/2019

5ca78d0a0e8825d5064fa92c autopsy Articles
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