Multiple cholesterol embolization syndrome: a lethal complication of vascular procedures. Report of two histologically proven cases

Two cases of multiple cholesterol embolization syndrome (MCES) leading to death are presented. Rarely described and labeled as a "great masquerader", its presence in the medical literature is growing, since it is best diagnosed, but despite the high frequency with which MCES may occur, only a few cases are reported. This syndrome is not universally recognised.

[Female gonadal venous insufficiency]

The varicocele is a disease recognized and studied in the man. Dilatation of the ovarian veins and the pelvic varicosities secondaries to a varicocele in the woman is a rarely described disease but, if it were researched, it could be more frequent. Diverse syndromes of chronic abdominal pain in the woman with unrecognized etiology and associated with urologic and/or gynecologic symptomatology could be caused by this pathology, but the absence of a clinical description difficult the diagnosis of the most part of cases. The practice of gonadal selective venographies shows a high percentage of dilatation of the gonadal veins associated to a dilatation of the pelvic veins and of the lower limbs veins. The study of the anatomy of the gonadal veins shows diverse anomalies respect to the classical descriptions. Furthermore, the varicocele could be the cause of a high part of the "essential" varicosities presents during the pregnancy. We present a case that instead of being treated by Services of Urology or Gynecology, it was treated by the Vascular Surgery Service. So, the literature about the respect was reviewed. We think that, some entities, like the feminine varicocele, ovarian vein syndrome, pelvic congestion syndrome chronic pelvic pain, pelvic varicosities, vulvar varicosities and some "essential" pregnant varicosities at the lower limbs could be enclosed into the same clinical entity (with a common etiology, physiopathology, clinical presentation and treatment). It should be intending to unify criteria (etiologic, diagnostic and therapeutics criteria) by the different Specialized Unities in such type of pathology.

[Vascular diseases masking malignant tumors of soft tissues]

Two case reports with Myxoid and Pleomorphic varieties of Malign Fibrohistiocytoma are presented. In both cases, the first consult took place in an Angiology and Vascular Surgery Service, because their clinical symptoms were similar in the first case to such produced by the arteriovenous fistulas and in the second case, symptoms remaid to an hematoma secondary to a varicose vein rupture. Such rare and malign tumors often are diagnosed as vascular diseases, and they may be discovered in the usual clinical practice, so its important an accurate recognition as well as an adequate treatment.

[Gigantic aneurysm of the popliteal artery]

A giant popliteal aneurysm case, whose first symptom was an acute ischemia on the limb, caused by thrombosis, which was successfully treated, is reported. Although popliteal aneurysm is not a rare event, the interest of this case is focused on its extraordinary size and unique location.