Abstract
Cholesterol emboli can occasionally be released from ulcerated atheromatous plaques located in large arterial vessels and subsequently lodge in the systemic capillary bed. These microemboli may, in turn, give rise to a multisystemic disorder, which has been named cholesterol crystal embolization (CCE). 1 Fine MJ Kapoor W Falanga V. Cholesterol crystal embolization: a review of 221 cases in the english literature. Angiology. 1987; 38: 769-784 Crossref PubMed Scopus (419) Google Scholar , 2 Francis J Kapoor WN. Intestinal pseudopolyps and gastrointestinal hemorrhage due to cholesterol crystal embolization. Am J Med. 1988; 85: 269-271 Abstract Full Text PDF PubMed Scopus (12) Google Scholar Such a clinical condition was first described by Panum 3 Panum PL. Experimentelle Beitrage zur Lehre von der Embolie. Virchows Arch A Pathol Anat Physiol. 1862; 25: 308-310 Crossref Scopus (104) Google Scholar in 1862; in 1945 Flory 4 Flory CM. Arterial occlusions produced by emboli from eroded aortic atheromatous plaques. Am J Pathol. 1945; 21: 549-565 PubMed Google Scholar categorized its pathologic aspects. In necropsy studies the prevalence of CCE ranges from 3% and 4% 5 Cross SS. How common is cholesterol embolism?. J Clin Pathol. 1991; 44: 859-861 Crossref PubMed Scopus (82) Google Scholar to 17.6%. 6 Gore I Collins DP. Spontaneous atheromatous embolization. Am J Clin Pathol. 1960; 33: 416-426 PubMed Google Scholar Gastrointestinal participation in CCE has been studied mainly through retrospective analysis of clinical series and occurs in nearly 10% of all cases. In these cases, digestive hemorrhage seems to be the most common clinical presentation. 1 Fine MJ Kapoor W Falanga V. Cholesterol crystal embolization: a review of 221 cases in the english literature. Angiology. 1987; 38: 769-784 Crossref PubMed Scopus (419) Google Scholar Although the endoscopic appearance of gastrointestinal involvement in CCE has been adequately described, 2 Francis J Kapoor WN. Intestinal pseudopolyps and gastrointestinal hemorrhage due to cholesterol crystal embolization. Am J Med. 1988; 85: 269-271 Abstract Full Text PDF PubMed Scopus (12) Google Scholar , 7 O'Brian DS Jeffers M Kay EW Hourihane D. Bleeding due to colorectal atheroembolism: diagnosis by biopsy of adenomatous polyps or of ischemic ulcer. Am J Surg Pathol. 1991; 15: 1078-1082 Crossref PubMed Scopus (15) Google Scholar , 8 Bank S Aftalion B Anfang C Altman H Wise L. Acquired angiodysplasia as a cause of gastric hemorrhage: a possible consequence of cholesterol embolization. Am J Gastroenterol. 1983; 78: 206-209 PubMed Google Scholar , 9 Korelitz BI. Atherosclerotic emboli. Dig Dis Sci. 1985; 30: 506 Crossref PubMed Scopus (5) Google Scholar a wide literature survey did not reveal a published endoscopic photograph. We herewith report a case of CCE presenting as an upper gastrointestinal hemorrhage. On UGI endoscopy distinct lesions were observed that later were confirmed by histologic study.
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