Cholesterol emboli pathology

Authors: Dr Achala Liyanage, Dermatology Fellow, Waikato Hospital, Hamilton, New Zealand; Assoc Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand. January 2015.

Cholesterol embolism occurs spontaneously or following vascular surgery. Cutaneous manifestations range from purpura and livedo to ulceration and gangrene.

Histology of cholesterol emboli

Microscopically, clefts indicating the sites of cholesterol deposition are seen in arterioles and arteries in the dermis and subcutis. Fibrin thrombi often surround the cholesterol. There may be extensive surrounding necrosis.

Images provided by Dr Duncan Lamont, Waikato Hospital

Special studies in cholesterol emboli

Usually none are required.

Differential diagnosis of cholesterol emboli

Deposits of atrial myxoma.

Deposit of material from intravenous injections (usually compounds mixed with illicit drugs).

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