Right Ventricular Perforation and Pulmonary Embolism With Polymethylmethacrylate Cement After Percutaneous Kyphoplasty

Abstract

A 58-year--old woman was referred to our center for further workup and treatment of a probable polymethylmethacrylate (PMMA) embolism to the right ventricle (RV) and right pulmonary artery. The patient’s medical history included hypertension, hypothyroidism, hyperlipidemia, and anxiety. She developed lower back pain ≈1 month before admission and was diagnosed with multiple compression fractures. Ten days before admission, the patient underwent percutaneous kyphoplasty of the T11, T12, and L1 vertebral bodies. A biopsy during that procedure revealed multiple myeloma as the underlying cause of the fractures. No vascular abnormalities were noticed at that time. A day before transfer she was readmitted with chest pain and shortness of breath. She was noted to have diffuse ST segment elevations on her ECG and mildly elevated cardiac troponin. Coronary angiography did not show evidence of obstructive coronary disease. However, fluoroscopy during coronary angiography showed foreign material in the RV and the pulmonary artery (Figure 1 and online-only Data Supplement Movie I). A computed tomography demonstrated foreign material in the RV and the pulmonary artery with a free wall perforation (Figure 2 and …