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A Review of 842 Cases Filed in the Dutch National Pathology Information System From 1973 Through 1994

Willem Moolenaar, MD; Cornelis B. H. W. Lamers, MD, PhD

Arch Intern Med. 1996;156(6):653-657.

Abstract
Objective
To clarify the incidence and clinical features of cholesterol crystal embolization (CCE).

Methods
Analysis of the relevant data of 842 diagnosed cases of CCE filed in the Dutch National Pathology Information System from 1973 through 1994.

Results
No report of CCE was recorded from 1973 through 1979. Since then, its incidence rose from 0.9 case per million population in 1980 to 6.0 cases per million population in 1985, but stabilized thereafter. Among autopsy reports, the relative percentage of CCE was similar over the years, with 0.35% in 1982 and 0.30% in 1994 (mean, 0.31%; range, 0.20% to 0.42%). Nine patients in whom CCE was found in their renal transplant were excluded from the study. Thus, among a total of 833 elderly (mean age, 72.1 years), predominantly male (73.9%) patients, 1066 CCE sites were found in 323 biopsy reports, 264 resection reports, and 287 autopsy reports.

Conclusions
In the Dutch population, CCE is reported steadily, with an average frequency of 6.2 cases per million population per year since 1985. It occurs predominantly in elderly men with a history of atherosclerotic disease and hypertension. Symptoms may be absent, go unrecognized, or mimic other disease processes. It can also be a coincidental finding. The primary CCE site is the kidney, followed by the skin and the gastrointestinal tract.

(Arch Intern Med. 1996;156:653-657)

Author Affiliations
From the Department of Internal Medicine, Wilhelmina Hospital, Assen, the Netherlands (Dr Moolenaar), and the Department of Gastroenterology and Hepatology, University Hospital, Leiden, the Netherlands (Dr Lamers).

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