Presentation
This patient diagnosed with multiple myeloma had a chest CT scan as part of the protocol to undergo bone marrow transplantation.
Patient Data
The CT images show multiple small tubular branching high dense opacities distributed in the segmental and subsegmental branches of pulmonary arteries bilaterally, predominantly on the right side, representing pulmonary acrylic cement embolism - polymethylmethacrylate (PMMA). There is also a PMMA fragment in the right ventricle. There is not lung infarction, nor pleural effusion.
There are widespread osseous changes of multiple myeloma, characterized by osteopenic bone, lytic lesions, and various vertebrae endplate fractures, resulting in kyphosis. CT features of status post vertebroplasty with cement in treated vertebral bodies T12, L1, and L2. The dense lines beyond the confines of these vertebral bodies correspond to leakage of PMMA into the perivertebral veins.
Impression: The CT features are consistent with post-vertebroplasty pulmonary cement embolism.
Case Discussion
Pulmonary cement embolism with polymethylmethacrylate (PMMA) is a complication following vertebroplasty and can be detected incidentally in asymptomatic patients undergoing chest CT scans 1-8. Radiologists should recognize pulmonary cement embolism's radiographic and CT features, contributing to guiding management 1,8.
This case illustrates the complication of vertebroplasty with the leak of the acrylic cement into the paravertebral veins leading to pulmonary PMMA embolism.
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