Bone cement migrated to the right heart resulting in perforation of the ventricular wall with cardiac tamponade.

Abstract

An 85-year-old man came to our emergency department because of acute shock due to cardiac tamponade. Four days ago, he underwent percutaneous vertebroplasty of the T12-L4 spine because of a compression fracture of the vertebral body, and post-operative X-ray suggested a leakage of bone cement from the L1 vertebra (Panel A). Computed tomography revealed a linear-shaped hyperattenuated lesion extending from the right heart into the pericardial cavity accompanied by massive pericardial effusion (Panel B). The patient underwent emergency surgery after pericardial puncture. Intra-operative transoesophageal echocardiography revealed a strong echo in the right ventricle (Panel C; Supplementary data online, Movie S1). The pericardial cavity was opened and plenty of clots were found, the foreign body was found on the surface of the right ventricle with sharp exposed end and was pulled out, and the right ventricular wall was repaired (Panel D; Supplementary data online, Movie S2). The foreign body was hard, formed a needle-shaped, measured ∼6×0.3 cm, and was diagnosed as bone cement (Panel E). Post-operative transoesophageal echocardiography revealed no obvious residuum in the heart or vena cava. The patient was in good condition initially after the surgery, but later died of respiratory failure caused by a severe pulmonary infection.