Pulmonary cement embolism secondary to vertebroplasty

Case contributed by Dr Yune Kwong

Presentation

Request for CXR reads as follows: "Pleuritic chest pain, dyspnoea, spinal op yesterday ?PE. Osteoporosis, severe ??rib fracture"

Patient Data

Age: 65-70 years
Gender: Female

See below. 

CT pulmonary angiogram (CTPA) is requested by the clinical team to exclude a pulmonary embolus.

On the standard soft tissue windows (1st stack), the pulmonary arteries enhance normally with no filling defects. On re-windowing to vascular windows (2nd stack), linear high density abnormalities are seen in the right main pulmonary artery and its segmental branches. Further abnormalities in the left pulmonary artery segmental branches.

Review of previous imaging.

On review of the patient's previous imaging, it becomes apparent that the patient had undergone 4 level vertebroplasty the previous day. This explains the abnormalities seen on CXR and CTPA: cement embolism. In retrospect, on the CXR, the vertebroplasty cement can just be seen on the bottom of the radiograph.

Case Discussion

Following vertebroplasty, the reported incidence of cement embolism ranges widely, from 2.1% to 26%1. Meticulous technique and high quality fluoroscopy are necessary to reduce the risks of cement leakage into the venous system or into surrounding soft tissues.

This case illustrates the importance of rewindowing angiographic studies to vascular windows, as the pulmonary artery cement could not be visualised on standard soft tissue windows.

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Case information

rID: 22072
Case created: 8th Mar 2013
Last edited: 12th Mar 2017
Inclusion in quiz mode: Included

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