Cholesterol emboli syndrome physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Physical Examination

• Chest pain due to myocardial ischemia
• Paradoxical embolus: presence of patent foramen ovale or atrial septal defect
• Other rare manifestations include retinal lesions, splenic infarcts, prostatitis, orchitis, hemorrhagic cystitis
• Fever

Abdomen

• Abdominal pain

  • Occult blood positive stool due to ischemia of the stomach, small intestine and colon
  • Less common manifestations include ischemic pancreatitis, focal liver cell necrosis and acalculous necrotizing cholecystitis.

• Renal failure

  • Acute or step-wise worsening function
  • Patients may demonstrate focal segmental glomerulosclerosis may be seen, presenting with progressive renal insufficiency, sometimes with significant proteinuria.

Neurologic

• Neurologic abnormalities

  • Mononeuritis multiplex
  • CNS involvement

Skin

• Cutaneous involvement – cutaneous involvement increases the likelihood of accurate diagnosis.

  • Blue toes / nail bed infarctions
  • Livedo reticularis – present in up to 50%
  • Cyanosis, purpura, tender nodules, ulcerations, gangrene

References

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