Pulmonary cement embolization after vertebroplasty

Case contributed by Domenico Nicoletti

Presentation

History of severe pain on the right side of the chest after ten days of vertebroplasty surgery for osteoporotic fracture of L3 vertebral body, without history of trauma to chest after surgery.

Patient Data

Age: 75 years
Gender: Female

Lumbosacral spine

x_ray

Vertebroplasty with typical appearance of cement within the L3 vertebral body. Note a leakage of extraosseous cement in the vertebral veins.

Showing linear branching opacities in all zones of both lungs, more evident in the upper lobes. Nothing else of significance to report.

Chest without contrast

ct

Bilateral linear opacities in pulmonary arteries suggestive of bone cement embolization. She was successfully managed without long term anticoagulation.

Case Discussion

Vertebroplasty is a procedure used to treat pain and deformity secondary to compression fractures or osteolytic metastases. Pulmonary cement embolization is due to accidental extravasation of bone cement into the valveless vertebral venous plexus, then reaching the thoracic venous system. Early injection into the liquid phase can cause extravasation of bone cement into the venous system and then migration to the lungs. The most common symptoms are chest pain and breathlessness. It can only rarely begin as acute respiratory distress syndrome. Symptoms generally come on later, sometimes weeks or months after the procedure. Most patients are asymptomatic.

Case courtesy Dr. Mashadi Mirza Riccardo

Radiographer: TSRM Fabio Imola

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