Acute Pericarditis Caused by Acrylic Bone Cement After Percutaneous Vertebroplasty
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).
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.