Cement embolism

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Admitted with COPD exac and possible CVA with witnessed aspiration.

Patient Data

Age: 84
Gender: Female
X-ray

1. The linear densities should not be in the lungs.

2. Some one can argue it is retained guidewire - less likely as it is very dense, discontinuous and when you window on CT it is tubular like a vessel.

Annotated image

IMPRESSION:

  1. Radiopaque linear density overlying the right hilum, concerning for cement embolization. Further evaluation with CT chest without contrast is recommended.
  2. Right upper lobe calcific density, which may represent a calcified granuloma or additional cement embolization.
  3. Thoracic vertebroplasty.
  4. Dense mitral valve annular calcification.
CT

2 high density structures in the right upper lobe is likely cement based on the cement in the paravertebral  veins also.Cement leak into the paravertebral veins can lead to pulmonary cement embolism.

Case Discussion

This is likely chronic and nothing to do now. Cement embolism is a well known complication of vertebroplasty. One should know of this procedure and complication when reading radiographs.

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Case information

rID: 41612
Case created: 10th Dec 2015
Last edited: 22nd Apr 2017
Inclusion in quiz mode: Included

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