Circulation. 1999;100:e48-e50
(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
|
|---|
 Top
 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).
|
|
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 (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 and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
