Pulmonary Cholesterol Crystal Embolization

Sabatine, Marc S.; Oelberg, David A.; Mark, Eugene J.; Kanarek, David J.

doi:10.1378/chest.112.6.1687

Cited by 38 publications

(32 citation statements)

References 42 publications

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“…So-called pulmonary-renal syndrome refers to a variety of disorders that are characterized by pulmonary hemorrhage and progressive renal insufficiency (9-ll Fabry's disease that presented with pulmonary and renal involvement have been reported (13)(14)(15)(16). However, the present case was extremely rare in that both diseases coexisted.…”

Section: Discussionmentioning

confidence: 67%

Atypical Fabry's Disease Presenting with Cholesterol Crystal Embolization.

Shirai¹,

Ohtake²,

Kimura

et al. 2000

Intern. Med.

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Wedescribe a 65-year-old manwho presented with pulmonary hemorrhage and progressive renal insufficiency three monthsafter resection surgery for an abdominalaortic aneurysm. Intensive treatment with corticosteroids and hemodialysis were not effective, and the patient died. Postmortemexamination of the kidneys revealed widespread cholesterol clefts within the renal arterioles and a number of lamellar inclusion bodies were observed by electron microscopy. The diagnosis of Fabry's disease was made by the absence of plasma a-galactosidase A activity. This was a very rare case of subclinical Fabry's disease coexistent with cholesterol crystal embolization, mimicking pulmonary-renal syndrome. (Internal Medicine 39: 646-649, 2000)

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Section: Discussionmentioning

confidence: 67%

Atypical Fabry's Disease Presenting with Cholesterol Crystal Embolization.

Shirai¹,

Ohtake²,

Kimura

et al. 2000

Intern. Med.

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“…KES'e ait laboratuar bulguları normokrom normositik anemi, löko-sitoz, eozinofili, sedimentasyon ve CRP yüksekliği ile hipokomplementemidir (5,14,19). Çeşitli çalışmalarda eozinofilinin hastaların yaklaşık olarak %25-75'inde görüldüğü belirtilmiştir (5,20).…”

Section: Discussionunclassified

“…Çeşitli çalışmalarda eozinofilinin hastaların yaklaşık olarak %25-75'inde görüldüğü belirtilmiştir (5,20). Bizim olgumuzda da hipokomplementemi dışında bu laboratuar bulguları mevcuttu.…”

Section: Discussionunclassified

Cholesterol Crystal Embolism Following Coronary Angiography: A Case Report

Demir¹,

Yürüyen²,

Müderrisoğlu³

et al. 2013

Istanbul Med J

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Kolesterol kristal embolisisi sendromu (KES) günümüzde damar içi girişimlerin ve trombolitik ajanlar, heparin gibi tedavilerin sık kullanılmasıyla beraber sıklığı artan ve son dönem böbrek yetmezliklerinin %3'ten fazlası-nın etyolojisinde yer alabilen bir sendromdur. Diyabetik, hipertansif, sigara kullanan erkek hastalarda daha çok görülür. Temel patogenez damar içi girişimlerden sonra yerinden oynayan ve distal arteryel dolaşıma katılan kolesterol kristallerinin endarterlerde yaptığı inflamatuar ve obliteratif prosestir. Sık etkilenen organların da böbrek, cilt, gastrointestinal sistem, ekstremiteler, olduğu düşünülürse klinikte kötüleşen hipertansiyon, ciltte purpura, ekimoz, karın ağrısı, kilo kaybı, böbrek fonksiyon testlerinde bozulma sıklıkla gözlenir. Bizim olgumuzda da yapılan koroner anjiografi sonrası, sağ ayak başparmağında gangren, böbrek fonksiyonlarında bozulma, hipertansiyonda kötüleşme gelişmişti. Yapılan Doppler USG'de tromboemboli saptanmayan hastada KES olasılığı düşünüldü. Böbrek biyopsisi ile de tanısı doğrulanan hastaya steroid ve iloprost tedavisi uygulandı. Her iki alt ekstremite distalindeki lezyonlarında progresyon gözlenmeyen hastanın akut böbrek yetmezliği tablosu, başlangıçta hemodiyaliz ihtiyacı olmasına rağmen tedavi sonrası giderek düzeldi. Anahtar Kelimeler: Koroner anjiografi, kolesterol embolisi, damar içi girişimCholesterol embolism is a syndrome that is increasing in prevalence with intravascular diagnostic interventions, and which may be an etiologic factor in more than 3% of end-stage renal diseases. It is detected more frequently in diabetic, hypertensive male patients who smoke. Therapeutic approaches include the use of thrombolytic agents and heparin. The fundamental pathogenesis is the inflammatory and obliterative process of cholesterol crystals which separate from their site and join the distal arterial flow after intravascular interventions. In the clinic, symptoms such as accelerating hypertension, purpura and ecchymosis, abdominal pain, loss of weight, and failure in renal-function tests are frequently observed, as the kidneys, skin, gastrointestinal system and extremities are the most affected organs. Our patient developed gangrene in the right toe, failure in renal-function tests, and acceleration in hypertension after a cardiac angiogram. When a thromboembolism was not detected by venous doppler ultrasonography, the patient was diagnosed with a cholesterol embolism. Steroid therapy was initiated when the patient's diagnosis was confirmed by renal biopsy. The acute renal failure improved after therapy, and those manifestations on the distal lower limb did not progress.

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“…[10][11][12] In the first present patient, CES as the cause of pulmonary disease could not be proven, as bronchoscopy could not be performed due to poor general status. However, it is possible that underlying pathology of the pulmonary disease was CES.…”

Section: Case Reportmentioning

confidence: 99%