Pulmonary Embolization of Acrylic Cement During Vertebroplasty
A 79-year-old man with a history of diastolic left ventricular dysfunction, atrial fibrillation, and low back pain underwent vertebroplasty. The procedure was uneventful except for the development of low-grade fever 1 day after the procedure. The patient denied any cough, dyspnea, or chest pain. Initial physical examination revealed that he was not in respiratory distress. His temperature was 38.3°C, respiratory rate was 20/min, blood pressure was 125/72 mm Hg, and pulse was 92 bpm and irregularly irregular. Auscultation of the lungs revealed normal breath sounds except for decreased air entry at both bases. Findings of the cardiac examination were normal, without distention of the jugular veins. He had 2+ pitting edema of the lower extremities. Initial work-up included a chest radiograph that revealed high-density linear shadows bilaterally (Figure 1). There were no previous chest radiographs for comparison. Chest computed tomography scan confirmed the presence of bilateral, multiple, linear hyperdensities within the pulmonary arteries, as well as a peripheral, wedge-shaped defect in the right middle lobe (Figure 2). Transthoracic echocardiograms did not show any evidence of elevation in the pulmonary arteries. In view of the patient’s recent vertebroplasty, these radiographic findings were attributed to pulmonary embolization of the acrylic cement (polymethylmethacrylate) used during the surgical procedure, which contains barium sulfate in the preparation, thus giving its radiopaque properties (Figure 3). The right middle lobe findings likely represented a pulmonary infarct. The patient did well without any long-term sequelae consistent with other reported cases of cement embolization in the literature.