Lesson of the week: Cholesterol emboli syndrome

doi:10.1136/bmj.321.7268.1065

BMJ 2000;321:1065-1067 ( 28 October )

Clinical review

Lesson of the week

Cholesterol emboli syndrome

Cholesterol embolism is a common but underrecognised complication arising from a variety of vascular insults

Peter J Dupont, specialist registrar ^a, Liz Lightstone, honorary consultant ^a, Elaine J Clutterbuck, honorary consultant ^a, Gillian Gaskin, honorary consultant ^a, Charles D Pusey, professor ^a, Terry Cook, reader in renal pathology ^b, Anthony N Warrens, honorary consultant ^a.

^a Renal Section, Imperial College School of Medicine, Hammersmith Hospital, London W12 0NN, ^b Department of Histopathology, Hammersmith Hospital

Correspondence to: A N Warrens a.warrens@ic.ac.uk

The first 150 words of the full text of this article appear below.

Cholesterol embolisation is a common complication of arteriography, vascular surgery, thrombolysis, and anticoagulation inelderly patients, but the diagnosis is often not considered. Wepresent three cases of cholesterol embolism seen at our renalunit over a six month period. The initial presentation in eachcase was acute renalfailure.

Case reports

Case 1
A 75 year old Indian Asian man presented tohis local hospital with unstable angina where he received conventionaltreatment with intravenous nitrates and heparin. His pain subsidedbut he subsequently developed recurrent episodes of "flash" pulmonaryoedema and recalcitrant hypertension. These were accompanied byan inexorable decline in renal function over four weeks untileventually he became dependent ondialysis.

Severe hypertension and signs of peripheral vascular disease were found on physical examination, but there were no audiblerenal bruits. Non-blanching purpuric lesions suggestive of embolisationwere noted on his toes. Blood tests showed a marked peripheralblood . . . [Full text of this article]

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