Presentation
Chest pain after spinal fixation surgery
Patient Data
There is no evidence of lung consolidation or pleural effusion.
Status post multilevel vertebral fixation and vertebroplasty with cement.
New radiopaque branching density overlying the right hilum.
Branching hyperdense material in the right upper lobe pulmonary artery also some smaller branches in the left upper lobe show some material of the same density. Rest of the pulmonary trunk, pulmonary artery, subsequent lobar and segmental branches show no other filling defects.
Bilateral small amount of pleural fluid and atelectatic changes.
Impression: Features are consistent with post-vertebroplasty pulmonary cement embolism.
Case Discussion
Known case of cervical cancer with multiple vertebral compression fractures; hence spinal fixation and vertebroplasty were performed.
Pulmonary cement embolism with polymethylmethacrylate (PMMA) is a complication following vertebroplasty and can be detected incidentally in asymptomatic patients undergoing chest CT 1,2.
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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