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(Circulation. 1998;97:1522.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Cholesterol Embolization

Unrecognized Complication of Thrombolysis

G. Pettelot, MD; J. Bracco, MD; D. Barrillon, MD; M. Baudouy, MD; ; P. Morand, MD

From the Departments of Cardiology and Nephrology, Hôpital Pasteur, Nice, France.

Correspondence to G. Pettelot, MD, Department of Cardiology, Hôpital Pasteur, 30 ave de la Voie Romaine, BP69–06002 Nice, France. E-mail pettelot{at}hotmail.com

A 62-year-old man was admitted to the hospital because of myocardial infarction. Treatment with 100 mg of recombinant tissue plasminogen activator was given intravenously for 90 minutes. On the second day, he presented abdominal and lower limb pain. Physical examination showed a toe and leg livedo reticularis (Fig 1). The biological evolution showed a progressive increase of creatinine, from 127 to 350 µmol/L until day 20.

View larger version (91K): [in this window] [in a new window]   Figure 1. Toe livedo reticularis.

A skin biopsy performed on the livedo confirmed the diagnosis of cholesterol embolization exhibiting cholesterol crystals in the intima of small arteries and in the lumen of the capillaries (Fig 2).

View larger version (135K): [in this window] [in a new window]   Figure 2. Biconvex, needle-shaped clefts surrounded by fibrin deposition in lumen of an arteriole. Clefts represent site where cholesterol crystals were lodged before they were dissolved for preparation of biopsy.

The patient did not have any arterial catheterism. Fibrinolysis, by destroying the platelet-fibrin thrombus of the atheromatous ulcerated plaques, allowed the liberation of the cholesterol crystals in 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.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pettelot, G. Articles by Morand, P. Search for Related Content PubMed PubMed Citation Articles by Pettelot, G. Articles by Morand, P.