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Cholesterol Embolism: Diagnosis Antemortem by Bone Marrow Biopsy

J. RUSH PIERCE Jr., M.D.; MICHAEL V. WREN, M.D.; and JOHN B. COUSAR Jr., M.D.
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Veterans Administration Hospital and Vanderbilt University School of Medicine; Nashville, Tennessee


Ann Intern Med. 1978;89(6):937-938. doi:10.7326/0003-4819-89-6-937
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Widespread cholesterol microembolism from atherosclerotic plaques may produce a multisystem illness resembling polyarteritis, allergic vasculitis, subacute bacterial endocarditis, or left atrial myxoma. The syndrome is characterized by hypertension, acute or chronic renal failure, neurologic abnormalities, retinal emboli, gastrointestinal hemorrhage, pancreatitis, and ischemic changes of the feet and legs such as purpura, livedo reticularis, gangrene, and nonhealing ulceration despite adequate arterial pulses (1). The diagnostic dilemma may be confounded by the frequent finding in cholesterol embolization of leukocytosis, eosinophilia, and elevated erythrocyte sedimentation rate. Characteristic yellow cholesterol emboli may be seen in retinal arteries (1). In previous reports antemortem diagnosis has

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