Pulmonary Artery Cement Embolism after a Vertebroplasty

Abstract

Background Context. Vertebroplasty is a minimally invasive procedure most commonly used for the treatment of vertebral compression fractures. Although it is relatively safe, complications have been reported over time. Among those complications, massive cement pulmonary embolism is considered a rare complication. Here we report a case of massive diffuse cement pulmonary embolism following percutaneous vertebroplasty for a vertebral compression fracture. Study Design. Case report. Methods. This is a 70-year-old female who underwent vertebroplasty for T11 and T12 vertebral compression fracture. Results. CT-scan revealed an incidental finding of cement embolism in the pulmonary trunk and both pulmonary arteries. Since the patient was asymptomatic, she was monitored closely and she did not need any intervention. Conclusion. Vertebroplasty is a minimally invasive procedure used for treatment of vertebral compression fracture. Despite the low rate of complications, a pulmonary cement embolism can occur. The consequences of cement embolism range widely from being asymptomatic to embolism that can cause paralysis, radiculopathy, or a fatal pulmonary embolism.

Cement pulmonary embolism after balloon kyphoplasty

“…The presentation can vary from an incidental radiological finding to a life-threatening event. Clinically, patients can exhibit dyspnea, tachypnea, cyanosis, dizziness, chest pain, cough, or hemoptysis; and eventually may lead to cardio-respiratory compromise [6,9].…”

“…A high index of clinical suspicion and imaging tools are crucial for the diagnosis of PCE. No screening methods have been implicated for asymptomatic patients, while some clinicians do recommend routine imaging after vertebral augmentation procedures [9,12]. A Chest X-ray revealing single or multiple high-density opacities in a tubular or branching pattern, matching to the pulmonary arterial distribution, is often indicative of PCE [2,3,9,10].…”

“…A CT angiogram of the chest should be performed to confirm the diagnosis. An echocardiogram is essential for a complete assessment, as cement can deposit in the right heart, and evaluate for secondary elevated pulmonary arterial pressure [2,9].…”

Pulmonary Embolism from Cement Augmentation of the Vertebral Body

“…Studies have reported PCE as solitary or multiple, tubular or branching, radiodense lines in the lungs on chest radiographs [ 4 11 ]. Also suggestive of PCE on chest radiography are areas of high-density opacity in a tubular branching pattern that correspond to the distribution of arteries [ 26 29 ]. In a study in which chest CT scans were used to document the presence of PCE, the detected PCEs were also evident on plain radiographs.…”

Pulmonary embolism with polymethyl methacrylate (bone cement) after percutaneous vertebroplasty (a review of literature and case reports)

“…В отличие от классической легочной тромбоэмболии, полиметилметакрилат (костный цемент) обладает значительно более высокой плотностью по сравнению с плотностью паренхимы легкого, что позволяет без особого труда распознавать ЭЛА у больных, перенесших ЧКВП, при проведении обычной РГ ОГК [37]. Чаще всего подобные эмболические осложнения ЧКВП описываются в виде единичных или множественных линейных или «ветвящихся» теней, реже -как участки затенения легочной ткани высокой плотности в проекции предполагаемого деления ветвей легочной артерии [30,32,34,41]. В этом плане интересны результа ты исследования D.H.Choe et al [32], по результатам которых показано, что во всех случаях визуализации ЭЛА при ЧКВП при использовании КТ ОГК соответствующие фрагменты костного цемента удавалось распознать и при анализе обычной РГ ОГК.…”