Cement embolism

Case contributed by Dr Jayanth Keshavamurthy

Presentation

COPD exacerbation and stroke with witnessed aspiration

Patient Data

Age: 85 years
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

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

Axial MIP: cement in the lumbar veins

Case Discussion

This is likely chronic and nothing required acutely. Cement embolism is a well-known complication of vertebroplasty. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.