How are cholesterol emboli diagnosed?

Cholesterol crystals within the lumina of the vessels on biopsy are diagnostic. The skin biopsy should ideally be an excision, and step sections should be examined because the atheromatous emboli are often focal. It is helpful to auscultate carefully over the major vessels of the abdomen and lower extremities after the patient has exercised to increase the pulse rate. This presentation is important because patients often have involvement of other organ systems, especially the kidneys. Further angiographic studies should be limited and treatment of the underlying hyperlipidemia initiated.

Manganoni AM, Venturini M, Scolari F, et al: The importance of skin biopsy in the diverse clinical manifestations of cholesterol embolism, Br J Dermatol 150:1230–1231, 2004.