[Pampiniform livedo--an acute cardinal symptom of a cutaneous cholesterol embolism]

Acute, painful, persisting, pampiniform and asymmetrical skin discolorations over the legs occurred after retrograde femoral artery catheterization in three patients suspected of having renal artery stenosis. The cause was found histologically to be embolization of cholesterol crystals to the arterioles of the corium-subcutis. Under treatment with acetylsalicylic acid the painful cutaneous changes gradually regressed. The possibility of cholesterol crystal emboli from atheromatous plaques in the aorta should be considered if the described skin changes occur, especially in the legs and with normal arterial pulsations. Proof lies in the histological picture of slit-like spaces in the arteriolar vessels at the corium-subcutis juncture, previously occupied by cholesterol crystals dissolved during fixation, and surrounding inflammatory changes with vessel wall thickening.