Yamasaki Masataka, Ikutomi Masayasu, Masuda Yoshio, Yamasaki Masao
Department of Cardiology, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Eur Heart J Case Rep. 2023 Oct 6;7(10):ytad482. doi: 10.1093/ehjcr/ytad482. eCollection 2023 Oct.
Most cases of cholesterol embolism are known to be triggered by cardiac catheterization, cardiovascular surgery, anticoagulation, or fibrinolytic therapy; however, spontaneous cases after aortic dissection are rare. In this report, we describe a case of cholesterol embolism after type B aortic dissection, which rapidly developed into multiple organ failure and death.
A 65-year-old man with untreated hypertension was admitted to our hospital with sudden back pain and diagnosed with type B aortic dissection. The patient experienced a rapid progression of inflammation and developed respiratory and renal failure, despite computed tomography showing no obvious progression of dissection. We attributed them to a cytokine storm and acute respiratory distress syndrome, but steroid pulse therapy did not alleviate the symptoms. Finally, the patient died on Day 6 after admission, and an autopsy was performed, which revealed cholesterol crystal occlusions in the kidney, spleen, and the left lower leg. The lumen in the aorta is filled with atheroma and thrombus, and we suspect that aortic dissection triggered failure of the aortic plaques and released cholesterol crystals to distal arteries that led to cholesterol embolism.
We experienced a patient with a type B aortic dissection that led to cholesterol embolism and rapid progression of respiratory and renal failure, resulting in death. The aortic dissection combined with cholesterol embolism was considered to trigger the subsequent severe inflammation, leading to rapid respiratory and renal failure. Our case points to the possibility that cholesterol embolism can extensively escalate inflammation after aortic dissection.
已知大多数胆固醇栓塞病例是由心脏导管插入术、心血管手术、抗凝治疗或纤维蛋白溶解疗法引发的；然而，主动脉夹层后出现的自发性病例却很罕见。在本报告中，我们描述了一例B型主动脉夹层后发生胆固醇栓塞的病例，该病例迅速发展为多器官功能衰竭并导致死亡。
一名65岁未接受治疗的高血压男性因突发背痛入院，被诊断为B型主动脉夹层。尽管计算机断层扫描显示夹层无明显进展，但患者炎症迅速进展并出现呼吸和肾衰竭。我们将其归因于细胞因子风暴和急性呼吸窘迫综合征，但类固醇冲击疗法未能缓解症状。最终，患者在入院第6天死亡，并进行了尸检，结果显示在肾脏、脾脏和左小腿发现胆固醇晶体栓塞。主动脉腔内充满动脉粥样硬化斑块和血栓，我们怀疑主动脉夹层引发了主动脉斑块破裂并将胆固醇晶体释放至远端动脉，从而导致胆固醇栓塞。
我们遇到了一名B型主动脉夹层患者，该夹层导致了胆固醇栓塞以及呼吸和肾衰竭的迅速进展，最终导致死亡。主动脉夹层合并胆固醇栓塞被认为引发了随后的严重炎症，导致迅速的呼吸和肾衰竭。我们的病例表明胆固醇栓塞可能在主动脉夹层后广泛加剧炎症。
