Cholesterol crystal embolization to liver, gallbladder, and pancreas.
We retrospectively studied the clinical features of all 44 patients (35 men, 9 women, mean age 74.5 years) registered with a diagnosis of hepatic, biliary, and/or pancreatic cholesterol crystal embolization (CCE) in the Dutch National Pathology Information System (DNPIS) from 1973 through 1994. Liver CCE was found in 12 (11 autopsies and 1 biopsy), gallbladder CCE in 2 (resection specimens), pancreas CCE in 19 (18 autopsies and 1 biopsy), and both liver and pancreas CCE in 11 (all autopsies) patients. Five patients presented with focal liver cell necrosis, 1 with acalculous necrotizing cholecystitis, 1 with chronic cholecystitis, 10 with necrotizing pancreatitis, and 1 with chronic fibrosating pancreatitis. Four patients died of CCE-induced pancreatitis. Nineteen patients died as a consequence of other CCE sites. These were reported in 37 patients. All patients had a history of atherosclerotic vascular disease. In half the patients a possibly CCE provoking factor (vascular surgery and/or cannulation, anticoagulant treatment) was present. We conclude that liver cell necrosis, cholecystitis, and pancreatitis may be caused by CCE, particularly in elderly male patients with a history of atherosclerosis.
Moolenaar
W
W
Department of Internal Medicine, Wilhelmina Hospital, Assen, The Netherlands.
Lamers
C B
CB
D000368:Aged; D001161:Arteriosclerosis / Q000150:complications; D002764:Cholecystitis / Q000209:etiology* / Q000473:pathology; D017700:Embolism, Cholesterol / Q000150:complications*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000209:etiology* / Q000473:pathology; D008297:Male; D009336:Necrosis / Q000209:etiology; D010195:Pancreatitis / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies