Peripheral Embolism from an Aortic-Arch Atheroma

Abstract

to the editor: In Images in Clinical Medicine (Dec. 11 issue), 1 Lee and Chandraratna provide evidence of dry gangrene in the right foot of a 62-year-old man and evidence of a mobile arch atheroma. They suggest that thromboembolism from atheroma is an important cause of stroke and peripheral em-bolism. We agree. However, we would suggest that this is not a case of " thromboembolism, " as it is characterized in the second paragraph. The pres-ence of both the dorsalis pedis and posterior tibial pulses in the affected foot suggests that there has not been a fibroplatelet embolic event. Indeed, this constellation is more suggestive of cholesterol crystal embolization — how else to explain the preserved pulses? Also, single-vessel infrapoplit-eal occlusion typically does not cause intermittent claudication, much less gangrene. We suggest that the transesophageal echocardiogram reveals a rup-tured plaque and substrate for cholesterol emboli, not thromboembolism.