Fujikawa Shohei, Iguchi Ryo, Noguchi Tetsuya, Sasaki Miharu
The Department of Urology, Shizuoka City Shizuoka Hospital.
Hinyokika Kiyo. 2015 Mar;61(3):99-102.
Cholesterol crystal embolization (CCE) is a cardiovascular disorder with poor prognosis, causing multiple organ failure. The primary pathological condition of the disease is embolization of cholesterol crystals in peripheral vessels. We report a case of CCE following urinary diversion. The patient is a 82-year-old male with history of hypertention, pneumonectasia, interstitial pneumonia, and heavy smoking. He was afflicted with advanced bladder cancer. He underwent urinary diversion, and had been scheduled for palliative radiotherapy. The next day, he developed thromboembolism of the left lower leg as acomplication of urinary diversion. Thrombectomy by endovascular catheter procedure was performed immediately, and anticoagulant therapy was started. The day after the thrombectomy, his lower legs showed livedo reticularis and toes showed cyanosis (blue toe). Since the laboratory data showed acute deterioration in renal function, hemodialysis was initiated. Three days after the thrombectomy he died of multiple organ failure. At autopsy, diffuse atherosclerosis of the aorta was observed, and cholesterol crystalemboli were found in the skin of the left foot ; and, the diagnosis of CCE was confirmed. This case suggests that tissue examinations for early diagnosis and stopping anticoagulant therapy are preferred when CCE is suspected.
胆固醇结晶栓塞（CCE）是一种预后不良的心血管疾病，可导致多器官功能衰竭。该病的主要病理状况是外周血管中胆固醇结晶的栓塞。我们报告一例尿流改道后发生CCE的病例。该患者是一名82岁男性，有高血压、肺扩张、间质性肺炎病史且重度吸烟。他患有晚期膀胱癌。他接受了尿流改道手术，并计划接受姑息性放疗。第二天，他出现左下肢血栓栓塞，这是尿流改道的并发症。立即通过血管内导管手术进行了血栓切除术，并开始抗凝治疗。血栓切除术后第二天，他的小腿出现网状青斑，脚趾出现发绀（蓝趾）。由于实验室数据显示肾功能急性恶化，遂开始进行血液透析。血栓切除术后三天，他死于多器官功能衰竭。尸检时，观察到主动脉弥漫性动脉粥样硬化，在左脚皮肤中发现胆固醇结晶栓子；CCE诊断得以证实。该病例表明，当怀疑CCE时，进行组织检查以早期诊断并停止抗凝治疗是更好的选择。
