Imaging

Cholesterol Emboli Syndrome

Preliminary Diagnosis: Cholesterol Emboli Syndrome

I. What imaging technique is first-line for this diagnosis?

  • CT with intravenous contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of cholesterol emboli syndrome.

Advantages

  • Specific to identify calcified and soft plaque using thin slices and reconstructions

  • Relatively inexpensive

  • Quick procedure

  • Can visualize complications including aneurysm, rupture, dissection, penetrating ulcer

  • In patients with atheroembolic phenomena, CT is useful to look for a source and provide an assessment of the extent of atherosclerosis.

Disadvantages

  • May underestimate amount of disease

III. What are the contraindications for the first-line imaging technique?

Relative contraindication includes exposure to ionizing radiation during pregnancy.

IV. What alternative imaging techniques are available?

  • MRI

  • Echocardiogram

  • Angiogram

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of cholesterol emboli syndrome.

MRI

Advantages

  • A mural thrombus causes irregularity of aorta

  • Able to visualize complications including aneurysm, dissection, and rupture

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize artifact

Echocardiogram

Advantage

  • Can assess for emboli from the heart

Disadvantage

  • Limited assessment of only the heart

Angiogram

Advantages

  • Can clearly see mural thrombus, narrowing, and flow dynamics

  • Can intervene in real-time when appropriate

Disadvantages

  • Expensive

  • Associated risks with invasive procedure

  • Exposure to ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

MRI

Absolute contraindication in patients with non-MR-compatible hardware

Echocardiogram

No significant contraindications

Angiogram

Relative contraindications include pregnancy

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