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(Circulation. 1999;100:e48-e50.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Cholesterol Embolism as a Complication of Aortic Dissection

Shota Nakamura, MD; Ikuo Misumi, MD; Shunichi Koide, MD

From the Department of Cardiology, Amakusa Medical Center, Hondo City, Japan.

Correspondence to Shota Nakamura, MD, Department of Cardiology, Amakusa Medical Center, 854-1, Jikiba, Kameba-Machi, Hondo City 863-0046, Japan.

	Introduction

 
A73-year-old man was admitted to the hospital because of severe back pain. CT and MRI (Figure 1) revealed aortic dissection. Transesophageal echocardiography (Figure 2) showed a thickened intimal tear of the thoracic aorta. The patient was treated with calcium blockers (cilnidipine and diltiazem) and a ß-blocker (metoprolol).

View larger version (88K): [in this window] [in a new window]   Figure 1. CT of chest shows aortic dissection in descending aorta, where thickened intima was observed (left). MRI shows dissection originating distal to left subclavian artery (right).

View larger version (102K): [in this window] [in a new window]   Figure 2. Transesophageal echocardiogram shows aortic dissection at thickened intima.

One month later, the patient complained of left leg pain. Physical examination showed left toe necrosis (Figure 3) and transient left leg livedo reticularis. The necrotic area gradually extended proximally, and the patient's leg was amputated. Histopathological study confirmed the diagnosis of cholesterol embolism exhibiting cholesterol crystals in the lumen of the small arteries (Figure 4).

View larger version (94K): [in this window] [in a new window]   Figure 3. Digital tip of left toe was necrotic.

View larger version (131K): [in this window] [in a new window]   Figure 4. Histopathology of amputated leg shows cholesterol crystals in lumen of small arteries, confirming cholesterol embolism.

The patient did not have catheterization studies or fibrinolytic therapy. We believe that the aortic dissection liberated cholesterol crystals into the arterial circulation.

	Footnotes

 
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital . . . [Full Text of this Article]