Cryoglobulinemia is uncommon in Southern Chinese in Hong Kong, with tropical climates and low incidence of hepatitis C virus (HCV) infection. Eight positive cases were detected among 481 patients screened for cryoglobulins over a 10-year period. Three HCV carriers (38%) ran benign courses. The others included two carriers of hepatitis B virus (HBV), two patients with adenocarcinoma, and one with chronic lymphocytic lymphoma. Four of them (except one HBV carrier) ran fulminant courses and died of cryoglobulin-related complications. Interestingly, all four cases also had structural aortic abnormalities, including multiple dissections, aneurysms, and congenital aortic arch abnormalities, which were often life threatening. The association of aortic abnormality and cryoglobulinemia is hitherto unreported and may be peculiar to our ethnic group. Aggressive control of the cryoglobulin may help to reduce aortic intima damage.