Radiologic features of pulmonary cement embolism after percutaneous vertebroplasty in a case and review of literature

Fatih Ateş,Abidin Kilinçer,Hakan Cebeci̇,Mehmet Sedat Durmaz

doi:10.38053/acmj.815944

Abstract

Percutaneous vertebroplasty is a well-known treatment modality for vertebral compression fractures caused by osteoporosis and malignant metastases. The procedure involves the injection of polymethyl methacrylate (PMMA, bone cement), into the desired vertebral body. Pulmonary cement embolism (PCE) refers to the embolization of PMMA into the pulmonary arteries. Patients are often asymptomatic and it may be detected incidentally for imaging done for another reason. The most common symptoms of pulmonary cement embolization are chest pain and breathlessness, and rarely it can present as acute respiratory distress syndrome. In this case, we aimed to present a 73-year-old male patient of PCE with computed tomography (CT) images. We want to raise the awareness that all patients undergoing vertebroplasty procedure should have routine chest X-ray after the procedure. However, CT is the best modality to determine PCE.

Highlights

Vertebroplasty is the procedure of percutaneous implantation of poly methyl methacrylate (PMMA) into the vertebral corpus with radiological imaging in situations such as compression fracture or height loss in the vertebra after trauma or many diseases [1]
Percutaneous vertebroplasty is a well-known treatment modality for vertebral compression fractures caused by osteoporosis and malignant metastases
We aimed to present a 73-year-old male patient of Pulmonary cement embolism (PCE) with computed tomography (CT) images

Summary

Introduction

Vertebroplasty is the procedure of percutaneous implantation of poly methyl methacrylate (PMMA) into the vertebral corpus with radiological imaging in situations such as compression fracture or height loss in the vertebra after trauma or many diseases (osteoporosis, metastatic lesions, etc.) [1]. After being injected in to the vertebral body, PMMA cement can reach the pulmonary artery via the paravertebral venous system and the azygos vein, causing PCE [3]. Patients usually do not describe symptomas and are detected incidentally on imaging performed for another reason, there are few reports of serious and fatal outcomes in the literature [4,5]. In this case report, we aimed to present PCE in a patient diagnosed with computed tomography (CT) in the light of the literature

Objectives

Discussion

Conclusion