Presentation
Known case of metastatic renal cell carcinoma. Underwent thoracic spine fixation with pedicle screw augmentation.
Patient Data
Complete bony cortical resorption and height loss of T6 and T7, in keeping with patient's known metastatic fractures.
Paraspinal metallic rods and fixating transpedicular screws extending from T3 to T10. Pedicle screw cement augmentation in T9 and T10. A small amount of epidural cement leakage is evident at these levels, more pronounced at the level of T10, with mild right foraminal extension.
A thin hyperdense curvilinear structure is seen within the lumen of the azygos vein, terminating in the azygos arch. It appears to communicate with the anterior cortex of T10. The findings are in keeping with cement intravasation.
No abnormal hyperattenuating foci are seen within the pulmonary vessels. No signs of cement embolism.
Cement intravasation
Curvilinear hyperdense material within the azygos lumen, terminating in the azygos arch, contiguous with the anterior cortex of T10 (red arrows).
Case Discussion
Cement intravasation can be a potentially life threatening complication of percutaneous vertebroplasty or pedicle screw augmentation. Cement leakage into the paravertebral veins may result in cement pulmonary or cerebral embolisms as well as cardiac perforation.