ATLAS OF RENAL PATHOLOGY

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Cholesterol Emboli

Pathology Editor: Agnes Fogo, MD
Medical Photographer: Brent Weedman

 
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Fig 1. Cholesterol emboli are visualized as clear spaces where the cholesterol crystals have been dissolved by routine processing. Cholesterol emboli usually lodge in vessels 100 to 200 microns in diameter. The early response of platelets and occasional mononuclear cells is seen in this medium size artery occluded by acute cholesterol emboli. (Jones Silver Stain, original magnification X200).
 
 
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Fig 2. Cholesterol emboli in later stages may show more fibrous organization surrounding the clefts. Multiple serial sections may be needed for diagnosis since diagnostic cholesterol emboli may be quite focal. (Jones' Silver Stain, original magnification X200).
 
 
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Fig 3. In this arteriole, three distinct cholesterol crystal clefts emboli are present with a small wisp of fibrin separating two of them, with surrounding early organization within the arteriolar wall. Rarely, cholesterol emboli may also be present in glomeruli (Periodic Acid Schiff, original magnification X400).
 
 
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Fig 4. In later stages of organization after cholesterol embolization, the lumen may have more fibrous reorganization surrounding the cholesterol clefts, as shown in this cholesterol embolus, biopsied 6 weeks after coronary arteriography. (Periodic Acid Schiff, original magnification X400).
 
 
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Fig 5. Cholesterol emboli are surrounded by mononuclear cells and foam cells with fibrous occlusion of this medium size artery. (Plastic Embedded Toluidine Blue Stain, original magnification X400).
 

From the Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
Address author queries to Agnes Fogo, MD, Department of Pathology, Vanderbilt University Medical Center, MCN C-3310, Nashville, TN 37232. E-mail:Agnes.Fogo@vanderbilt.edu
Am J Kidney Dis 37(3):E19, 2001 (available www.ajkd.org)
 Copyright 2001 by the National Kidney Foundation, Inc.

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