Review Question - QID 104489

This patient has cholesterol emboli syndrome after his cardiac catheterization, which commonly results in eosinophiluria.

Cholesterol emboli syndrome often follows angiography and is the result of a disrupted plaque moving down the blood stream and lodging in tiny vessels throughout the body. This can present as acute renal failure, pancreatitis, gastrointestinal symptoms, and a characteristic "blue toe," formally called livedo reticularis. Interestingly, eosinophiluria is also characteristic of this condition. Treatment is primarily medical risk factor reduction. Statin therapy is indicated to reduce rate of recurrent embolism.

Crownover and Jones describe a case of cholesterol emboli syndrome in a patient with atrial fibrillation who never underwent cardiac catheterization. It was suggested that patients on warfarin (many of whom have atrial fibrillation) are at an increased risk of cholesterol embolization because clots are unable to stabilize on atherosclerotic plaque surfaces, allowing cholesterol contents to then embolize.

Quinones et al. review cholesterol embolization syndrome in atherosclerosis. They note that the syndrome is characterized by waves of arterio-arterial embolization of cholesterol crystals and atheroma debris from the aorta and progressing to arteries around 100-200 microns in diameter.

Image A shows livedo reticularis, a mottled reticulated vascular pattern that appears like a lace-like purplish discoloration of the skin as a result of cholesterol embolism.

Incorrect Answers:
Answer 1: Hyponatremia is not a result of cholesterol embolization unless it results in long standing renal failure.
Answer 2: HYPERkalemia rather than HYPOkalemia would be a result of renal failure caused by severe cholesterol emboli syndrome.
Answer 3: Granular urinary casts are a non-specific finding and may be present in this situation but are not as likely as eosinophiluria.
Answer 4: Urinary leukophilia is not characteristic of cholesterol emboli syndrome.