Pulmonary atheroembolism via an AV shunt.
Although cholesterol crystal embolism can present with diffuse visceral involvement, lung lesions do not occur unless there is left to right circulatory shunting. Pulmonary atheroembolism was confirmed by histology in an elderly male with recent end-stage renal failure (ESRF) due to atheroembolic renal disease, who presented with massive hemoptysis and intractable respiratory failure. At autopsy, atheromatous degeneration of the aorta was observed and acute cholesterol emboli found in the kidneys, spleen, liver, stomach and lung. Cholesterol clefts were seen in pulmonary arterioles, and ischemic alveolar damage was present. The pulmonary arteries had no atheromatous changes. Intrapulmonary, intracardiac, and aortocaval shunting were not present. Pulmonary atheroembolism arising from a dialysis fistula has not been previously reported.
Kono
Y
Y
Department of Nephrology, Teine Keijinkai Hospital, Teine-Ku, Sapporo, Japan. nana-yuri@mui.biglobe.ne.jp
Takizawa
H
H
Yamaji
I
I
Takada
T
T
Shinohara
T
T
Tanaka
S
S
McGill
R L
RL
D000208:Acute Disease; D000368:Aged; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D017700:Embolism, Cholesterol / Q000150:complications / Q000209:etiology* / Q000601:surgery; D017809:Fatal Outcome; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D008099:Liver / Q000473:pathology; D008168:Lung / Q000473:pathology; D008297:Male; D011655:Pulmonary Embolism / Q000150:complications / Q000209:etiology* / Q000601:surgery; D006435:Renal Dialysis; D012131:Respiratory Insufficiency / Q000209:etiology; D012769:Shock / Q000209:etiology; D013154:Spleen / Q000473:pathology; D013270:Stomach / Q000473:pathology; D034941:Upper Extremity / Q000601:surgery