Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.
Percutaneous vertebroplasty (PV) is an interventional radiologic procedure that involves injection of polymethylmethacrylate (PMMA) bone cement into a cervical, thoracic, or lumbar vertebral body lesion for the relief of pain and the strengthening of bone in symptomatic vertebral compression fractures [
Passage of bone cement into the venous system and then inferior vena cava, subsequently, into the lungs is one of the rare and serious complications of PV [
We present a case of a 48-year-old man who was admitted to our hospital with dyspnea on postoperative first day of PV and diagnosed as pulmonary cement embolism (PCE).
A 48-year-old man was admitted to our hospital with a complaint of dyspnea, which occurred within the first 24 hours after vertebroplasty. His anamnesis revealed the use of corticosteroids for six months with the diagnosis of chorioretinitis. Because of iatrogenic osteoporosis, he underwent vertebroplasty with the diagnosis of an osteoporotic vertebral fracture in another hospital. Posteroanterior (PA) chest radiography showed linear densities that are consistent with linear atelectasis in the left lower zone and elevation of the left diaphragm (Figure
PA radiography showed linear densities in the left lower zone and elevation of the left diaphragm.
Cement leakage to the azygos vein was detected in thorax CT.
Axial view of thorax CT showing multiple, linear hyperdensities in bilateral lobar pulmonary artery branches.
Coronal view of thorax CT.
PV is a widely applied therapeutic approach for symptomatic vertebral compression fractures, especially those of osteoporotic origin, and for osteolytic vertebral tumors [
The only risk factor identified for the development of PCE is fluoroscopic evidence of cement leakage to the azygos vein or vena cava during vertebroplasty [
In 38 to 73% of cases, cement leaks into the perivertebral tissue but remains silent in most cases [
Since most cases are initially asymptomatic, many cement emboli are found incidentally on subsequent imaging. That is why routine chest radiography is recommended after vertebroplasty [
Treatment of PCE reduces the risk of thrombus formation, pulmonary embolism, pulmonary infarction, and respiratory failure. In the literature, treatment is recommended based on the severity of symptoms, location, and size of the pulmonary embolism [
Patients with respiratory symptoms after vertebroplasty should be evaluated carefully in terms of pulmonary cement embolism.
The authors declare that there is no conflict of interests regarding the publication of this paper.