Cholesterol crystal embolization to liver, gallbladder, and pancreas

Moolenaar, Willem; Lamers, C. B. H. W.

doi:10.1007/bf02088752

Cited by 33 publications

(20 citation statements)

References 10 publications

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“…[1][2][3][42][43][44] Gastrointestinal bleeding most often results from superficial mucosal ulcerations, erosions, or mucosal infarcts. Clinical presentation may range from occult blood loss and melena to bloody diarrhea, depending on the site and extent of the lesions.…”

Section: Gastrointestinal Involvementmentioning

confidence: 99%

“…Pancreatitis is a rare presentation, although the pancreas is a frequent site of emboli. [1][2][3]41,44 Clinically, overt hepatitis is rare, and it is characterized by focal liver cell necrosis downstream of lodged arteriolar cholesterol crystals, with an increase in transaminase levels. 44 Acalculous necrotizing cholecystitis has been reported rarely as a complication of atheroembolism.…”

Section: Gastrointestinal Involvementmentioning

confidence: 99%

“…[1][2][3]41,44 Clinically, overt hepatitis is rare, and it is characterized by focal liver cell necrosis downstream of lodged arteriolar cholesterol crystals, with an increase in transaminase levels. 44 Acalculous necrotizing cholecystitis has been reported rarely as a complication of atheroembolism. [42][43][44] Intestinal symptoms, consisting mostly of nausea, emesis, abdominal pain, diarrhea, and gastrointestinal bleeding, were present in 10% to 33% of the patients in the largest patient series published.…”

Section: Gastrointestinal Involvementmentioning

confidence: 99%

“…44 Acalculous necrotizing cholecystitis has been reported rarely as a complication of atheroembolism. [42][43][44] Intestinal symptoms, consisting mostly of nausea, emesis, abdominal pain, diarrhea, and gastrointestinal bleeding, were present in 10% to 33% of the patients in the largest patient series published. 2,3,11,12 In our series, gastrointestinal involvement manifested as abdominal pain, diarrhea, and gastrointestinal bleeding in 16% of 52 patients.…”

Section: Gastrointestinal Involvementmentioning

confidence: 99%

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Cholesterol crystal embolism: A recognizable cause of renal disease

Scolari

Tardanico

Zani

et al. 2000

American Journal of Kidney Diseases

248

256

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• Cholesterol crystal embolism, sometimes separately designated atheroembolism, is an increasing and still underdiagnosed cause of renal dysfunction antemortem in elderly patients. Renal cholesterol crystal embolization, also known as atheroembolic renal disease, is caused by showers of cholesterol crystals from an atherosclerotic aorta that occlude small renal arteries. Although cholesterol crystal embolization can occur spontaneously, it is increasingly recognized as an iatrogenic complication from an invasive vascular procedure, such as manipulation of the aorta during angiography or vascular surgery, and after anticoagulant and fibrinolytic therapy. Cholesterol crystal embolism may give rise to different degrees of renal impairment. Some patients show only a moderate loss of renal function; in others, severe renal failure requiring dialysis ensues. An acute scenario with abrupt and sudden onset of renal failure may be observed. More frequently, a progressive loss of renal function occurs over weeks. A third clinical form of renal atheroemboli has been described, presenting as chronic, stable, and asymptomatic renal insufficiency. The renal outcome may be variable; some patients deteriorate or remain on dialysis, some improve, and some remain with chronic renal impairment. In addition to the kidneys, atheroembolization may involve the skin, gastrointestinal system, and central nervous system. Renal atheroembolic disease is a difficult and controversial diagnosis for the protean extrarenal manifestations of the disease. In the past, the diagnosis was often made postmortem. However, in the last decade, awareness of atheroembolic renal disease has improved, enabling us to make a correct premortem diagnosis in a number of patients. Correct diagnosis requires the clinician to be alert to the possibility. The typical patient is a white man aged older than 60 years with a baseline history of hypertension, smoking, and arterial disease. The presence of a classic triad characterized by a precipitating event, acute or subacute renal failure, and peripheral cholesterol crystal embolization strongly suggests the diagnosis. The confirmatory diagnosis can be made by means of biopsy of the target organs, including kidneys, skin, and the gastrointestinal system. Thus, Cinderella and her shoe now can be well matched during life. Patients with renal atheroemboli have a dismal outlook. A specific treatment is lacking. However, it is an important diagnosis to make because it may save the patient from inappropriate treatment. Finally, recent data suggest that an aggressive therapeutic approach with patient-tailored supportive measures may be associated with a favorable clinical outcome.

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Section: Gastrointestinal Involvementmentioning

confidence: 99%

Section: Gastrointestinal Involvementmentioning

confidence: 99%

Section: Gastrointestinal Involvementmentioning

confidence: 99%

Section: Gastrointestinal Involvementmentioning

confidence: 99%

See 2 more Smart Citations

Cholesterol crystal embolism: A recognizable cause of renal disease

Scolari

Tardanico

Zani

et al. 2000

American Journal of Kidney Diseases

248

256

View full text Add to dashboard Cite

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“…95,96 The liver, gallbladder and pancreas are less commonly involved. 88 Hepatic involvement is usually clinically silent except for a modest increase in transaminase levels 97 while patients with pancreatic involvement may develop an acute pancreatitis, extensive necrotizing pancreatitis, or a chronic fibrosing pancreatitis. [97][98][99] Involvement of the gallbladder may present as a chronic acalculous cholecystitis or an acute necrotizing cholecystitis.…”

Section: Gastrointestinal Involvementmentioning

confidence: 99%

Atheromatous embolization

Liew

Bartholomew

2005

Vasc Med

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Atheromatous embolization is a multisystem disease complicating advanced atherosclerosis. It occurs most often as a complication of angiography, an endovascular procedure or cardiovascular surgery. Atheromatous embolization can present in a subtle manner where it is often under-recognized, or with catastrophic results including myocardial infarction, strake or acute renal failure. It may mimic other disease processes and often goes underdiagnosed and undertreated. A high clinical suspicion is the key to diagnosis. Atheromatous embolization results in significant morbidity and mortality; therefore, early recognition followed by aggressive management may help to prevent end-organ damage and improve overall clinical outcomes. Management strategies should include risk factor modification, prevention of further insults by discontinuing or avoiding predisposing factors, supportive treatment and interventional or surgical approaches to remove the atheroembolic source. Atheromatous embolization is expected to increase as our population ages and the epidemics of diabetes mellitus and obesity increase.

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Acalculous ischemic gallbladder necrosis in the catastrophic antiphospholipid syndrome

Dessailloud

Papo

Vaneecloo

et al. 1998

Arthritis & Rheumatism

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A 29-year-old woman was referred for abdominal pain. Results of tests for lupus anticoagulant and antibodies to phosphatidylserine and to P,-glycoprotein I were positive, but the patient had no features of systemic lupus erythematosus (SLE). Abdominal ultrasonography showed a thickening of the gallbladder wall without cholelithiasis. A surgical procedure revealed necrotic areas of the gallbladder wall, and a cholecystectomy was performed. Histologic examination of the gallbladder showed multiple thrombi and no vasculitis. Despite full-dose heparin, the patient developed a catastrophic antiphospholipid syndrome (APS) and subsequently died. Among connective tissue disorders, acute acalculous cholecystitis has been reported in patients with polyarteritis nodosa and/or SLE. APS should be considered as a possible cause of acalculous cholecystitis.The antiphospholipid syndrome (APS) may be responsible for diverse manifestations affecting the liver and/or gut (1,2), but to date, gallbladder involvement has not been described. We describe here a patient who developed acalculous ischemic gallbladder necrosis as a feature of catastrophic APS. CASE REPORTA 29-year-old nulliparous woman was referred for abdominal pain of recent onset. Her medical history was unremarkable. She had been taking an estrogencontaining contraceptive pill for years, and used to smoke 10 cigarettes per day. On cxaniination, she was

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Cholesterol crystal embolization to liver, gallbladder, and pancreas

Cited by 33 publications

References 10 publications

Cholesterol crystal embolism: A recognizable cause of renal disease

Cholesterol crystal embolism: A recognizable cause of renal disease

Atheromatous embolization

Acalculous ischemic gallbladder necrosis in the catastrophic antiphospholipid syndrome

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