대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 550 Date 2008-05-12

  • Courtesy of Semin Chong, MD. / Chung-ang University Hospital, Korea.
  • Age/Sex 52 / F
  • Chief ComplaintDyspnea
  • Figure 1
  • Figure 2

Diagnosis With Brief Discussion

Diagnosis
Pulmonary cement embolism after vertebroplasty
Radiologic Findings
Chest radiograph shows multiple linear or branching calcifications along the pulmonary vessels in both lungs.

Non-contrast chest CT scan shows multiple, round or branching calcifications along the pulmonary arteries in both lungs.

Enhanced chest CT scan shows low attenuated filling defect with high attenuated material within the infrahepatic IVC, suggesting IVC thrombosis with cement emboli.

Bone window image of L4 vertebral body shows venous leakage of the cement after vertebroplasty.
Brief Review
1. Complication of vertebroplasty
1) Cement leak : up to 73%
2) Venous leak : up to 24%
3) Pulmonary cement embolism : up to 4.6%
4) Infection, temporary pain, allergic reactions and HBP

2. Pulmonary cement embolism
- Venous cement leak -> risk ↑
- Liquid consistency of PMMA
- Treatment of malignant lesion due to cortical destruction and higher vascularity
- Mostly asymptomatic, chest pain, dyspnea
- Radiographic findings: Multiple tubular or branching dense pulmonary opacities
- Treatment: in symptomatic patient, anticoagulation therapy to reduce risk of thrombus formation
References
Du Hwan Choe, Edith M. Marom, Kamran Ahrar, Mylene T. Truong, and John E. Madewell Pulmonary Embolism of Polymethyl Methacrylate During Percutaneous Vertebroplasty and Kyphoplasty Am. J. Roentgenol., 2004; 183: 1097 - 1102.
Keywords
Vascular, Lung, Embolic, Thromboembolic,

No. of Applicants : 84

▶ Correct Answer : 50/84,  59.5%
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Osaka University , Japan Osamu Honda
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - All India Institute of Medical Sciences , India puneet kochar
  • - Asan Medical Center , Korea (South) Eun Jin Chae
  • - Lilavati Hospital & Research Centre , India Mahavir Swami
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - St. Mary Hospital , Korea (South) GUK JUNG
  • - Catholic Medical Center , Korea (South) Min Sung Kim
  • - Hopital universitaire Lausanne , Switzerland abed kourhani
  • - Pe d , France Fabrice Bing
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - Regional Imaging Ltd. - Riverina, NSW, Australia , Australia Rashid Hashmi
  • - ICL , France Regis Labroye
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - University of Wisconsin , United States Jeffrey Grossman
  • - Daegu Fatima Hospital , Korea (South) Tae-Hun Kim
  • - Cheongshim international medical center , Korea (South) yang Hae Jum
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - UNIFESP-EPM , Brazil GUSTAVO MEIRELLES
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Department of Radiology, Catholic University of Korea , Korea (South) So Yeon Lee
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - McGill University Health Center , Canada Alexandre Semionov
  • - EKH-Berlin , Germany Michael Weber
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - CMC , Korea (South) An yi
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Dept. radiology, Chung-Ang univ. , Korea (South) JIN KYOUNG KIM
  • - EKH-Berlin , Germany Holger Hartmann
  • - radiology department ANNECY , France gilles GENIN
  • - CH de la Ce Basque , France Paul ARDILOUZE
  • - All India Institute of medical sciences , India Justin Moses
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - CHR ANNECY , France Olivier Segall
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - CHRU lille , France manuel toledano
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - CMC , Korea (South) Kim Mi Young
  • - Yonsei University college of medicine Severance hospital , Korea (South) Hua Sun Kim
  • - Jackson Memorial Hospital , United States Naganathan Mani
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - IRSA La Rochelle France , France Denis Chabassie
  • - UVA , United States Rachita Khot
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
  • - Soonchunhyang University Cheonan Hospital , Korea (South) Park Sang Hyun
▶ Correct Answer as Differential Diagnosis : 1/84,  1.2%
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
▶ Semi-Correct Answer : 10/84,  11.9%
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - hospital Sao Paulo , Brazil israel missrie
  • - , Korea (South) Kwon Kim
  • - apollo hospitals , India harish bhambore
  • - OSWAL CANCER HOSP. , India vishal garg
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - ottawa , Canada nishard abdeen
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Apollo Hospital, Ahmedabad. , India Sandip R Shah
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