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Case Reports: Monday, November 1, 2010 |

Pulmonary Cement Embolism: Rare Complication of Kyphoplasty FREE TO VIEW

Aleksander Shalshin; Navdeep Brar, MD; Shalinee Chawla, MD; Tasbirul Islam, MBBS
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Winthrop University Hospital, Mineola, NY



Chest. 2010;138(4_MeetingAbstracts):13A. doi:10.1378/chest.10723
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INTRODUCTION: Percutaneous vertebroplasty and Kyphoplasty are procedures done for compression fractures. Polymethylmethacrylate cement mixed with opacifying agent is injected under radiological guidance as a liquid and it quickly hardens and stabilizes the collapsed vertebra. Some degree of local leakage of cement during the procedure is very common. We report a case of a cement pulmonary embolism following kyphoplasty procedure.

CASE PRESENTATION: 62-yr-old female with L2 compression fracture was admitted for Kyphoplasty.Polymethylmethacryate was injected under fluoroscopic guidance. Extravasation of the cement was noted. CT scan of Lumbar Spine was performed which confirmed extravasation of cement reaching border of Inferior vena cava.Subsequent CT of the chest showed cement in right upper and middle lobe pulmonary arteries.Physical exam was unremarkable.Patient remained hemodynamically stable. She had no complains of chest pain, shortness of breath, hemoptysis etc. and ABG showed no hypoxia.Patient was subsequently started on therapeutic enoxaparin. She was discharged home later without anticoagulation.

DISCUSSIONS: Complications due to kyphoplasty and vertebroplasty are low and include infection, hypotension and leakage of cement outside the vertebral body. Occasionally, polymethylmethacrylate extravasates outside the vertebral body and extends into epidural and paraspinal veins, extending into inferior vena cava and may result in pulmonary embolism. Factors determining risk of pulmonary embolism are insufficient polymerization of cement, needle position with respect to vertebral vein and overfill of vertebral body. Most leaks are asymptomatic. In patients with clinical evidence of pulmonary embolism, management mainly consists of anticoagulation because there is risk of thrombus formation on the cement embolus.

CONCLUSION: Physicians should be aware of possibility of cement pulmonary embolism. It could potentially be fatal. Few cases have been reported.It is recommended that this procedure should be done under fluoroscopic/ CT guidance. As soon as leakage into perivertebral veins is seen, procedure should be discontinued.

DISCLOSURE: Aleksander Shalshin, No Financial Disclosure Information; No Product/Research Disclosure Information

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References

PhillipsF et al. An In Vivo Comparison of the Potential for Extravertebral Cement Leak After Vertebroplasty and Kyphoplasty.Spine200227,2173–2179. [CrossRef]
 
GangiA , Kastler, BA, Dietemann, JL.1994; Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy. AJNR Am J Neuroradiol.
 

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References

PhillipsF et al. An In Vivo Comparison of the Potential for Extravertebral Cement Leak After Vertebroplasty and Kyphoplasty.Spine200227,2173–2179. [CrossRef]
 
GangiA , Kastler, BA, Dietemann, JL.1994; Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy. AJNR Am J Neuroradiol.
 
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