Autopsy and Case Reports
Autopsy and Case Reports
Article / Clinical Case Report

Cholesterol crystal embolism to the gastrointestinal tract: a catastrophic case

Miao Tian; Karen E Matsukuma

Downloads: 2
Views: 977


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.


Cholesterol, Embolism, Gastrointestinal Tract, Ischemia


Flory CM. Arterial occlusions produced by emboli from eroded aortic atheromatous plaques. Am J Pathol. 1945;21(3):549-65. [PMID:19970827]

Kassirer JP. Atheroembolic renal disease. N Engl J Med. 1969;280(15):812-8. []. [PMID:4887250]

Eliot RS, Kanjuh VI, Edwards JE. Atheromatous embolism. Circulation. 1964;30(4):611-8. []. [PMID:14211824]

Saric M, Kronzon I. Aortic atherosclerosis and embolic events. Curr Cardiol Rep. 2012;14(3):342-9. []. [PMID: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. []. [PMID:12873565]

Moolenaar W, Lamers CB. Cholesterol crystal embolization in the Netherlands. Arch Intern Med. 1996;156(6):653-7. []. [PMID: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. []. [PMID: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. []. [PMID:20517183]

Moolenaar W, Lamers CB. Cholesterol crystal embolisation to the alimentary tract. Gut. 1996;38(2):196-200. []. [PMID: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. []. [PMID:20976733]

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

Moolenaar W, Lamers CB. Cholesterol crystal embolization and the digestive system. Scand J Gastroenterol Suppl. 1991;188(Suppl 188):69-72. []. [PMID: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. []. [PMID: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. [PMID: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. []. [PMID: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. []. [PMID: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. []. [PMID: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. []. [PMID:29624512]

Tunick PA, Kronzon I. Atheromas of the thoracic aorta: clinical and therapeutic update. J Am Coll Cardiol. 2000;35(3):545-54. []. [PMID:10716454]

Quinones A, Saric M. The cholesterol emboli syndrome in atherosclerosis. Curr Atheroscler Rep. 2013;15(4):315. []. [PMID:23423524]




Publication date:

5ca78d0a0e8825d5064fa92c autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections