eMedicine Specialties > Dermatology > Internal Medicine

Cutaneous Manifestations of Cholesterol Embolism: Multimedia

Author: Laura F McGevna, University of Vermont College of Medicine
Coauthor(s): Molly T Hogan, MD, Resident Physician, Department of Dermatology, University of Minnesota Medical School; Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle
Contributor Information and Disclosures

Updated: Feb 23, 2009

Multimedia

A 76-year-old man with a history of aortobifemora...
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Media file 1: A 76-year-old man with a history of aortobifemoral bypass graft developed this eruption after an angiographic procedure. This image shows the plantar surface of the right foot with some of the discoloration resulting from petechiae arranged in a reticulated pattern. This is not livedo reticularis. Petechiae do not blanch on diascopy, but the lesions of livedo reticularis do blanch.
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A 76-year-old man with a history of aortobifemora...

A 76-year-old man with a history of aortobifemoral bypass graft developed this eruption after an angiographic procedure. This image shows the plantar surface of the right foot with some of the discoloration resulting from petechiae arranged in a reticulated pattern. This is not livedo reticularis. Petechiae do not blanch on diascopy, but the lesions of livedo reticularis do blanch.

Aorta with an ulcerated plaque (black arrowhead) ...
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Media file 2: Aorta with an ulcerated plaque (black arrowhead) on the luminal side photographed under water to enhance reflection of cholesterol crystals (white arrowhead).
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Aorta with an ulcerated plaque (black arrowhead) ...

Aorta with an ulcerated plaque (black arrowhead) on the luminal side photographed under water to enhance reflection of cholesterol crystals (white arrowhead).

Low-power view of a skin biopsy specimen demonstr...
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Media file 3: Low-power view of a skin biopsy specimen demonstrating an arteriole within the subcutaneous fat occluded with thrombus material that contains (black arrowhead) needle-shaped cholesterol clefts (hematoxylin and eosin stain, original magnification X40).
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Low-power view of a skin biopsy specimen demonstr...

Low-power view of a skin biopsy specimen demonstrating an arteriole within the subcutaneous fat occluded with thrombus material that contains (black arrowhead) needle-shaped cholesterol clefts (hematoxylin and eosin stain, original magnification X40).

High-power view of occluded vessel (hematoxylin a...
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Media file 4: High-power view of occluded vessel (hematoxylin and eosin stain, original magnification X100). Same patient as in Media File 3.
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High-power view of occluded vessel (hematoxylin a...

High-power view of occluded vessel (hematoxylin and eosin stain, original magnification X100). Same patient as in Media File 3.

Symmetric involvement of the feet with livedo ret...
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Media file 5: Symmetric involvement of the feet with livedo reticularis on the plantar surface of the forefoot and cyanosis of the left fifth toe. The painful cyanotic toe is typical of blue toe syndrome.
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Symmetric involvement of the feet with livedo ret...

Symmetric involvement of the feet with livedo reticularis on the plantar surface of the forefoot and cyanosis of the left fifth toe. The painful cyanotic toe is typical of blue toe syndrome.

Dorsal surface of the toes of the right foot (sam...
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Media file 6: Dorsal surface of the toes of the right foot (same patient as in Media File 1). This image shows cyanosis of the fourth toe. The dominant eruption is petechial. Note the pallor of the tip of the great toe and the second toe. This finding indicates acute loss of perfusion.
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Dorsal surface of the toes of the right foot (sam...

Dorsal surface of the toes of the right foot (same patient as in Media File 1). This image shows cyanosis of the fourth toe. The dominant eruption is petechial. Note the pallor of the tip of the great toe and the second toe. This finding indicates acute loss of perfusion.

Plantar surface of the right foot. The distal hal...
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Media file 7: Plantar surface of the right foot. The distal half of the great toe is gangrenous, with a sharp demarcation between the necrotic tissue and the normal proximal skin. Livedo reticularis is present on the distal plantar forefoot, and petechiae are present on the distal pad of the second and fourth toes.
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Plantar surface of the right foot. The distal hal...

Plantar surface of the right foot. The distal half of the great toe is gangrenous, with a sharp demarcation between the necrotic tissue and the normal proximal skin. Livedo reticularis is present on the distal plantar forefoot, and petechiae are present on the distal pad of the second and fourth toes.

The lower extremities show well-developed livedo ...
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Media file 8: The lower extremities show well-developed livedo reticularis and focal areas of erosion and ulceration.
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The lower extremities show well-developed livedo ...

The lower extremities show well-developed livedo reticularis and focal areas of erosion and ulceration.

Photomicrographs of histologic sections of an aor...
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Media file 9: Photomicrographs of histologic sections of an aorta with van Gieson stain. (Left) An atherosclerotic plaque with the fibrous cap (black arrowhead) overlying a necrotic core of cellular debris, extracellular lipids, and cholesterol clefts (white arrowhead). Underneath the plaque is the elastic media (arrow). (Right) A ruptured atherosclerotic plaque exposing the atheromatous debris containing cholesterol crystals to the bloodstream on the luminal side of the aorta.
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Photomicrographs of histologic sections of an aor...

Photomicrographs of histologic sections of an aorta with van Gieson stain. (Left) An atherosclerotic plaque with the fibrous cap (black arrowhead) overlying a necrotic core of cellular debris, extracellular lipids, and cholesterol clefts (white arrowhead). Underneath the plaque is the elastic media (arrow). (Right) A ruptured atherosclerotic plaque exposing the atheromatous debris containing cholesterol crystals to the bloodstream on the luminal side of the aorta.

CT scan of an infrarenal abdominal aortic aneurys...
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Media file 10: CT scan of an infrarenal abdominal aortic aneurysm showing the mural thrombosis (white arrowhead) and the bright atherosclerotic calcifications (black arrowhead).
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CT scan of an infrarenal abdominal aortic aneurys...

CT scan of an infrarenal abdominal aortic aneurysm showing the mural thrombosis (white arrowhead) and the bright atherosclerotic calcifications (black arrowhead).

More on Cutaneous Manifestations of Cholesterol Embolism

Overview: Cutaneous Manifestations of Cholesterol Embolism
Differential Diagnoses & Workup: Cutaneous Manifestations of Cholesterol Embolism
Treatment & Medication: Cutaneous Manifestations of Cholesterol Embolism
Follow-up: Cutaneous Manifestations of Cholesterol Embolism
Multimedia: Cutaneous Manifestations of Cholesterol Embolism
References
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Further Reading

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Keywords

cholesterol embolism CE, cholesterol embolism syndrome, CE syndrome, atheroembolization, cholesterol crystal embolization, multiple cholesterol emboli syndrome, cholesterol microembolization, cholesterol emboli, atheromatous embolization, atherosclerosis, atherosclerotic cardiovascular disease, microthrombi, limb ischemia

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Contributor Information and Disclosures

Author

Laura F McGevna, University of Vermont College of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Molly T Hogan, MD, Resident Physician, Department of Dermatology, University of Minnesota Medical School
Molly T Hogan, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle
Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Catharine Lisa Kauffman, MD, FACP, Georgetown Dermatology and Georgetown Dermpath
Catharine Lisa Kauffman, MD, FACP is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Royal Society of Medicine, Society for Investigative Dermatology, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey
Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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