Methyl Methacrylate Mimicking a Retained Guide Wire

Abstract

Acute dyspnea developed in a 50-year-old woman 3 days after T3 vertebroplasty with the use of methyl methacrylate (MMA). A linear radiodensity more than 50 cm in length with uniform diameter was seen in the pulmonary arteries on a computed tomographic (CT) pulmonary angiogram, resembling a retained guide wire. Follow-up gated CT angiography demonstrated a linear high-density nonmetallic structure in the pulmonary arteries, with points of discontinuity and with a point of origin from the T3 vertebroplasty material, representing a hardened strand of extravasated MMA (Figure 1, Figure 2). Supportive care with supplemental oxygen was provided, and the patient’s dyspnea resolved during the next 3 days. Surgical or percutaneous retrieval were not undertaken because of concerns for fragmenting the MMA and causing further embolization. A 2-month follow-up chest radiograph demonstrated the MMA in unchanged positioning and morphology (Fig 3) while the patient remained asymptomatic. Three-dimensional reconstruction in right anterior oblique projection showed the MMA in its entirety (Fig 4, blue). Arrows in Figure 1, Figure 2, Figure 3 point to MMA. Arrowhead in Figure 1 points to MMA. Figure 2 View Large Image Figure Viewer Download Hi-res image Figure 3 View Large Image Figure Viewer Download Hi-res image Figure 4 View Large Image Figure Viewer Download Hi-res image