1. PATIENT PRESENTATION
A 77‐year‐old woman with type 2 diabetes mellitus presented to the emergency department (ED) with fever and urinary frequency, who was admitted with the diagnosis of urosepsis. During the hospital stay, computed tomography (CT) of the abdomen was performed because of persistent fever despite antibiotic treatment. A catheter‐like material in the inferior vena cava with the Hounsfield units of 420–480 was disclosed.
2. DIAGNOSIS
Venography with removal of the foreign body was attempted (Figure 1). Surprisingly, one fragment of bone cement was retrieved (Figure 2). Tracing her previous records, she had undergone vertebroplasty 2 years ago for a T‐spine compression fracture. After the fragment was removed, the patient remained asymptomatic with regular follow‐up at outpatient department.
FIGURE 1.
Computed tomography of abdomen demonstrating a catheter‐like foreign body in the inferior vena cava (arrow)
FIGURE 2.
The retrieved bone cement
Percutaneous injection of bone cement is widely used in augmentation procedures for thoracolumbar compression fracture of vertebra. 1 Cement leakage to paravertebral venous system was reported with incidence of 24% venous leaks from a total of 73% leaks. 2 Most of the patients are asymptomatic, although some of them may present with abdominal pain, back pain, and even chest pain and dyspnea resulting from venous thromboembolism. The management of inferior vena cava cement is controversial, although it may be associated with severe complications including pulmonary embolism and cardiac tamponade. Successful endovascular intervention for the retained bony cements may achieve significantly symptomatic improvement. Cement embolism could present as catheter‐like material in the inferior vena cava. Hounsfield units in CT images might provide a quantitative clue. Although clotted blood typically has a value of 50–100 Hounsfield units, a central venous catheter has a value of 1000–1200 Hounsfield units, and cortical bone has a value of 1000–2000 Hounsfield units, the radiopacity of a bone cement varies from 68 to 1473 Hounsfield units. Such evidence points out that the diagnostic difficulty merely depends on Hounsfield unit values. Being highly aware of this disease along with careful history taking may prevent misdiagnosis and overtreatment.
Liu Y‐L, Lin W‐S, Lin C‐S. Elderly woman with fever and urinary frequency. JACEP Open. 2020;1:648–649. 10.1002/emp2.12057
Funding and support: The authors received funding from The Tzer Study Group for Human Medical Research Foundation (B1081013).
[Correction added on 27 May 2020, after first online publication: the funding information is added.]
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