CHOLESTEROL CRYSTAL EMBOLIZATION TO LIVER, GALLBLADDER, AND PANCREAS

We retrospectively studied the clinical features of all 44 patients (3 5 men, 9 women, mean age 74.5 years) registered with a diagnosis of he patic, biliary, and/or pancreatic cholesterol crystal embolization (CC E) in the Dutch National Pathology Information System (DNPIS) from 197 3 through 1994. Liver CCE was found in 12 (11 autopsies and 1 biopsy), gallbladder CCE in 2 (resection specimens), pancreas CCE in 19 (18 au topsies and 1 biopsy), and both liver and pancreas CCE in 11 (all auto psies) patients. Five patients presented with focal liver cell necrosi s, 1 with acalculous necrotizing cholecystitis, 1 with chronic cholecy stitis, 10 with necrotizing pancreatitis, and 1 with chronic fibrosati ng pancreatitis. Four patients died of CCE-induced pancreatitis. Ninet een patients died as a consequence of other CCE sites, These were repo rted in 37 patients. All patients had a history of atherosclerotic vas cular disease. In half the patients a possibly CCE provoking factor (v ascular surgery and/or cannulation, anticoagulant treatment) was prese nt. We conclude that liver cell necrosis, cholecystitis, and pancreati tis may be caused by CCE, Particularly in elderly male patients with a history of atherosclerosis.