Unrecognized Complication of Thrombolysis
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.
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⇓).
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.\.
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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