A 65‐year‐old woman with a medical history of osteoporosis and L3–L5 spondylolisthesis presented to the emergency department with a 10‐day history of cough, pectoralgia, and dyspnea. Two weeks before the presentation, she underwent minimally invasive transforaminal lumbar interbody fusion and vertebroplasty. She reported no fever, chills, or hemoptysis. Heart rate was 76 beats/min, and respiratory rate was 22 counts/min, with 100% oxygen saturation while under nasal cannulation at 3 L/min. Chest radiography showed a radiopaque mass in the heart with multiple cement embolisms in the right pulmonary vessels (Figure 1A). Chest computed tomography revealed cement embolisms in the right ventricle and segmental pulmonary arteries of the right lung (Figure 1B). The diagnosis was pulmonary cement emboli in the right ventricle. The patient underwent surgical removal of the emboli in the right ventricle and right pulmonary artery by cardiopulmonary bypass. Cement emboli adhering to the anterior wall of the right ventricle and obstructing the right pulmonary artery bifurcation were noted intraoperatively (Figure 1C, D). In Figure 1D, the cement emboli in the right ventricle are placed in the middle and right side of the photo, whereas the cement emboli of the right pulmonary artery are on the left side. On day 11 after surgery, the patient was discharged from the hospital in good condition.
FIGURE 1.
Chest radiography showed a radiopaque mass in the heart with multiple cement embolisms in the right pulmonary vessels (A). Chest computed tomography revealed cement embolisms in the right ventricle and segmental pulmonary arteries of the right lung (B). Cement emboli adhering to the anterior wall of the right ventricle and obstructing the right pulmonary artery bifurcation were noted intraoperatively (C with arrow and D).
Intracardiac cement embolism (ICE) is a rare complication of vertebroplasty, and removal should be considered for symptomatic ICE. A low incidence (3.9%) had been reported in a single‐center retrospective analysis, and it was even more rare to have symptomatic complications related to ICE (0.3%). 1 Dyspnea and cough were reported among the patients of ICE with symptoms. 1 The synthetic material, such as polymethyacrylate, may leak from the injection site via the anterior vertebral veins during percutaneous vertebroplasty. 2 Anticoagulants were used for asymptomativ patients to prevent thromboembolic events induced by ICE and to obtain time for epithelialization of ICE. 3 Surgical or percutaneous retrieval should be considered for symptomatic ICE. 3
In summary, ICE is a rare complication of vertebroplasty, and removal should be considered for symptomatic ICE either with surgical or percutaneous retrieval.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
REFERENCES
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