This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Park, J.-H. Articles by Park, S.-W. Search for Related Content PubMed PubMed Citation Articles by Park, J.-H. Articles by Park, S.-W. Related Collections CT and MRI Echocardiography CV surgery: other Related Article

(Circulation. 2005;111:e98.)
© 2005 American Heart Association, Inc.

Images in Cardiovascular Medicine

Acute Pericarditis Caused by Acrylic Bone Cement After Percutaneous Vertebroplasty

Jae-Hyeong Park, MD; Suk Jung Choo, MD; Seong-Wook Park, MD, PhD

From the University of Ulsan College of Medicine, Seoul, South Korea.

Correspondence to Seong-Wook Park, MD, PhD, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea. E-mail swpark{at}amc.seoul.kr

Acute pericarditis caused by foreign material without trauma is rare. In the following case, acrylic bone cement penetrated the right ventricle (RV) after percutaneous vertebroplasty (PVP).

A 66-year-old woman presented with chest pain exacerbated by deep inspiration and recumbency. She had received PVP 8 days earlier to treat a vertebral compression fracture. Her chest radiograph showed fractured vertebra filled with bone cement in the ninth thoracic vertebral body (Figure, A). ECG showed ST-segment elevation in all precordial leads. Echocardiogram showed pericardial effusion and penetration of the RV by a fish bone–like material (Figure, B). Computerized tomogram revealed hemopericardium, penetration of the RV by a foreign body, and foreign materials in the right atrium (Figure, C). The contents removed after open-heart surgery revealed acrylic bone cement (Figure, D).

View larger version (112K): [in this window] [in a new window]   Chest radiograph showing compression fracture and bone cement in the ninth thoracic vertebral body (A). Echocardiogram (B) and computerized tomogram (C) revealed pericardial effusion (arrow) and a penetrated foreign body in the right ventricle (arrowheads). Computerized tomogram (C) also indicated another foreign body in the right atrium. Foreign bodies removed after open-heart surgery were pieces of needle-shaped acrylic cement (D).

PVP is a minimally invasive technique used mainly for the treatment of vertebral fractures in osteoporosis and metastasis. Immediate pain relief is reported in up to 80% of cases. The risk of cement extravasation into the venous system and the spinal canal represents the major hazard of this technique. The leakage of acrylic cement outside the vertebral body occurs in up to 65% of cases but remains silent in most of them.

The exact mechanism of how fish bone–like acrylic cement reached the RV is unknown. We surmise that acrylic cement of very low viscosity injected into the vertebral body drained into the inferior vena cava through the paravertebral venous plexus, where it hardened and drained into the RV, causing acute pericarditis.

Related Article:

Issue Highlights
Circulation 2005 111: 717. [Full Text]

This article has been cited by other articles:

				W. C. Little and G. L. Freeman Pericardial Disease Circulation, March 28, 2006; 113(12): 1622 - 1632. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Park, J.-H. Articles by Park, S.-W. Search for Related Content PubMed PubMed Citation Articles by Park, J.-H. Articles by Park, S.-W. Related Collections CT and MRI Echocardiography CV surgery: other Related Article