NEJM临床医学影像经导管主动脉瓣

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ImagesinClinicalMedicineCholesterolEmbolizationafterTranscatheterAortic-ValveReplacementLuDevy,M.D.,FlorenceBrunet-Possenti,M.D.BichatHospitalParis,Francedevy.lu87

yahoo.frNEnglJMed;:e25

An88-year-oldmanwithahistoryofmyocardialinfarctionforwhichhehadrequiredquadruplecoronary-arterybypassgraftingpresentedwithmottled-appearingpurplediscolorationoftheskinonhistoes.Onemonthearlier,hehadundergonetransapicaltranscatheteraortic-valvereplacement(TAVR).Thediscolorationoftheskinonhistoes(PanelsAandB)wasconsistentwithlivedoreticularis.Laboratoryfindingswerenotableforaserumcreatininelevelof2.8mgperdeciliter(μmolperliter),whichhadincreasedfromabaselinelevelof1.4mgperdeciliter(μmolperliter),andawhite-cellcountof10,permicroliterwith13%eosinophils(absoluteeosinophilcount,permicroliter).Askin-biopsysamplerevealedobstructivecholesterolcrystalsinmidsizedarteries,whichconfirmedthediagnosisofthecholesterolembolizationsyndrome(PanelsCandD).Thissyndromeiscausedbydistalshoweringofcholesterolcrystalsandcaninvolvemanyorgansystems,includingtheperipheralvasculature,kidneys,andbrain.Itisawell-described







































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