Synonym(s)
Cholesterol emboli; Cholesterol Embolisation Syndrome; Cholesterol Embolism; Cholesterol embolization syndromes
HistoryThis section has been translated automatically.
Panum, 1862
DefinitionThis section has been translated automatically.
Embolisation of small vessels by cholesterol crystals probably from arteriosclerotic plaques, which may occur spontaneously, after angiography, aortic surgery or after therapy with anticoagulants, streptokinase and plasminogen activator.
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EtiopathogenesisThis section has been translated automatically.
Spontaneously occurring or as a result of vascular surgery, oral anticoagulation, thrombolytic therapy, angiography or trauma
ManifestationThis section has been translated automatically.
Especially in men > 60 years of age; in the past history often hypertension and nicotine abuse.
Clinical featuresThis section has been translated automatically.
In previously unmodified skin suddenly appearing, differently sized, bizarrely configured, red-livid spots (image of livedo racemosa in about 35% of cases). Acutely occurring, usually very painful, bizarrely limited, often poorly documented, flat ulcers.
LaboratoryThis section has been translated automatically.
BSG and leukocyte elevation. Transient eosinophilia in 80% of cases.
HistologyThis section has been translated automatically.
Cholesterol crystals in the vascular lumen (only detectable in serial sections!), which appear as intravascular spindle-shaped clefts. Perivascular mixed cell, often eosinophilic infiltrate.
DiagnosisThis section has been translated automatically.
Clinic with livedo racemosa without other signs of vasculitis. Pain in the extremities, kidney failure possible. High age and arteriosclerosis as well as previous vascular surgery speak for the diagnosis.
Differential diagnosisThis section has been translated automatically.
Deep vein thrombosis; diabetic ulcer; live symptoms of other genesis; interstitial nephritis; myocardial infarction; acute gastritis; acute pancreatitis.
TherapyThis section has been translated automatically.
Symptomatic: pain therapy. In individual cases success with pentoxifylline has been described.
Notice!
Important is the treatment of the basic internal disease. Cave! Do not use oral anticoagulants, heparin or ACE inhibitors.External therapyThis section has been translated automatically.
In the initial stage of erythematous inflammatory changes, short-term external glucocorticoids, e.g. 0.05% betamethasone cream R028 or 0.25% prednicarbate cream/ointment (e.g. Dermatop) and moist compresses In case of extensive ulceration, removal of necroses, enzymatic wound cleansing (e.g. Iruxol N ointment) or hydrocolloid dressings (e.g. Varihesive extra thin). S.a.u. Wound treatment.
Operative therapieThis section has been translated automatically.
Smaller ulcerations can also be completely excised and primarily closed.
LiteratureThis section has been translated automatically.
- Gibbs MB et al (2005) Livedo reticularis: an update. J Am Acad Dermatol 52: 1009-1019
- Lukacs A et al (1992) Cutaneous, ulcerated cholesterol embolism under the image of a livedo racemosa after cardiac catheterization. Nude Dermatol 18: 14-16
- Panum PL (1862) Experimental contributions to the theory of embolism. Virchows Arch 25: 308-310
- Pennington M, et al (2002) Cholesterol embolization syndrome: cutaneous histopathological features and the variable onset of symptoms in patients with different risk factors. Br J Dermatol 146: 511-517
- Resnik KS (2003) Intravscular cholesterol clefts as an incidental finding. At J Dermatopathol 25: 497-499
- Scolari F et al (2000) Cholesterol crystal embolism: A recognizable cause of renal disease. On J Kidney Dis 36: 1089-1109
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Outgoing links (6)
Anticoagulants; Betamethasone valerate cream 0.05-0.1% (w/o); Glucorticosteroids topical; Livedo (overview); Livedo racemosa (overview); Wound treatment;Disclaimer
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.
Prof. Dr. med. Peter Altmeyer
