The seabed-like appearance of atherosclerotic plaques: three-dimensional transesophageal echocardiographic images of the aortic arch causing cholesterol crystal emboli.
Cholesterol crystal embolism (CCE) is a rare but important complication of endovascular procedures or anticoagulation therapy. An 84-year-old man was referred to the Gunma University Graduate School of Medicine with the diagnosis of acute myocardial infarction. After successful emergency coronary angioplasty, his serum creatinine level increased continuously. A subsequent skin biopsy confirmed that the patient had CCE. Transesophageal echocardiography (TEE) clearly demonstrated the mobile mass protruding from the complex atheroma. Three-dimensional TEE provides more precise and attractive volumetric images of the atherosclerotic plaque than two-dimensional TEE. In addition, the findings of this case revealed contrast media-induced nephropathy and CCE as possible causes of renal dysfunction after endovascular procedures.
Negishi
Kazuaki
K
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Gunma, Japan. kazz.negishi@nifty.com
Tsuchiya
Hiroko
H
Nakajima
Masahiro
M
Goto
Kosaku
K
Kurosawa
Koji
K
Fukuda
Nobuaki
N
Takahashi
Rieko
R
Nakano
Akihiko
A
Kurabayashi
Masahiko
M
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000000981:diagnostic imaging; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000379:methods; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D017700:Embolism, Cholesterol / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004638:Emergency Treatment; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000628:therapy; D018570:Risk Assessment; D016896:Treatment Outcome
D003287:Contrast Media; D003404:Creatinine