Cholesterol Crystal Embolism: Autopsy-proven Gastrointestinal Lesions, Pancreatitis, and End-stage Kidney Disease Which Developed after Undergoing Selective Abdominal Angiography

Figures

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  Figure 1.. Transfemoral angiography. a: The celiac artery was enhanced (yellow arrow). b: The superior mesenteric artery was enhanced (yellow arrow). The right hepatic artery was branched from the SMA. c: The abdominal aortic lumen was narrow on CT during hepatic arteriography (CTHA) (yellow arrow). d: Calcification of the abdominal aorta was evident on CTHA (yellow arrow).

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  Figure 2.. CT images. a: Postrenal obstruction, pancreatic enlargement, or gastric perforation was not observed. b: Perforation of the small intestine or colon was not observed. c: A diffuse enlargement of the pancreas was observed on hospital day 135.

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  Figure 3.. Esophagogastroduodenoscopy. a: An active gastric ulcer in greater curvature on hospital day 32. b: An active gastric ulcer in antrum on hospital day 32. c: An active gastric ulcer in the greater curvature improved to the scar stage on hospital day 98.

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  Figure 4.. a: A skin biopsy was performed on the left toe with cyanosis (yellow-dotted arrow). b: The skin biopsy revealed cholesterol clefts on light microscopy (×100).

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  Figure 6.. Clinical course of the case. ASV: acyclovir, MEPM: meropenem, DRPM: Doripenem, CEZ: cefazolin, BIPM: Biapenem, MNZ: metronidazole, VCM: vancomycin, CHDF: continuous hemodiafiltration, Eos: eosinophils, CRBSI: catheter-related bloodstream infections, DHZ: disseminated cutaneous herpes zoster, CPA: cardiopulmonary arrest

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  Figure 5.. a: Autopsy revealed severe atherosclerotic plaque in the aorta (yellow arrow). b: The stomach revealed diffuse mucosal erosion and intramural hemorrhaging. c: The jejunum revealed intramural hemorrhaging and coagulation necrosis. d: Cholesterol was eroded severely from the abdominal aorta (×40). e: Gastric cholesterol clefts on light microscopy (×100). f: Pancreatic cholesterol clefts (×100). g: Jejunal cholesterol clefts (×100). h: Renal cholesterol clefts on light microscopy (×100).