Images in Clinical Medicine
Pulmonary Cement Embolism after Vertebroplasty
N Engl J Med 2012; 366:258January 19, 2012
- Article
A 61-year-old man with spinal cord compression caused by a vertebral hemangioma underwent therapeutic laminectomy of the fifth vertebra and laminectomy and vertebroplasty of the fourth vertebra. During the vertebroplasty, polymethylmethacrylate cement leaked into the paravertebral vascular system. In the recovery room, the patient was mildly hypoxemic but otherwise asymptomatic. A chest radiograph and an image subsequently obtained with computed tomography revealed that some of the injected cement had embolized and entered the systemic circulation, where it lodged in the segmental and subsegmental pulmonary arteries of the middle lobes and the superior segment of the lower lobe (arrows) of the right lung. Transthoracic echocardiography indicated that the mean pulmonary arterial pressure was 45 mm Hg (reference range, 10 to 22 mm Hg). Embolism of injected cement to the pulmonary arteries is a known potential complication of vertebroplasty. Although most patients are asymptomatic, serious illness and even death may result. This patient was asymptomatic and normoxic when discharged from the hospital after 3 days of treatment with supplemental oxygen and clinical observation. At a 1-year follow-up visit, ventilation–perfusion scintigraphy showed persistent hypoperfusion of the right superior lobe, and transesophageal echocardiography revealed evidence of persistent mild pulmonary hypertension.
Jean-Pierre Tourtier, M.D.
Sophie Cottez, M.D.
Military Hospital Val-de-Grâce, Paris, France
