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Weekly Chest CasesArchive of Old Cases

Case No : 736 Date 2011-12-05

  • Courtesy of Yoon Kyung Kim, Eun Young Kim, Yon Mi Sung. / Gachon University Gil Hospital
  • Age/Sex 75 / F
  • Chief ComplaintBack pain
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1. (3weeks ago)

Diagnosis With Brief Discussion

Diagnosis
Pulmonary artery cement embolism
Radiologic Findings
Posteroanterior chest radiograph (Fig. 2) after vertebroplasty at T10 body shows dense, linear opacities in right lung. On the chest CT scan (Fig. 3 & 4), dense embolic materials are noted within the pulmonary arteries in right lung. Thoracic spine CT (Fig. 5) obtained after vertebroplasty revealed the leakage of bone cement into the right paravertebral vein.

Figure 5.

Brief Review
The proposed mechanism of cement pulmonary embolization is generally thought to involve initial leakage of cement into the surrounding paravertebral venous system. During vertebroplasty, cement leakage outside of the vertebral body has been reported to occur in 30% to 72% of cases. In limited retrospective studies, the overall frequency of cement pulmonary embolization after kyphoplasty and vertebroplasty has been found to be approximately between 1.7% and 6.8%. Various clinical presentations and outcomes after pulmonary cement embolization have been reported in the literature. A number of cement emboli cases have been discovered in apparently asymptomatic patients. The recorded symptoms and sequelae include chest pain, shortness of breath, leg swelling (edema), hypotension, arrhythmias, heart failure, pulmonary hypertension, and severe respiratory distress. The presence of high density opacities in the chest should raise the possibility of cement emboli. These densities may be rounded, linear, or branching in appearance, the latter 2 the most suggestive of the diagnosis. Serpentine cement densities in the paravertebral veins, azygous or cava may be well seen on some plain radiographs. There is only limited experience with management of MMA cement pulmonary emboli. A small number of case reports exist in the literature of pulmonary cement emboli treated surgically. There is also very little literature in regards to medical management of cement pulmonary embolization.
Anticoagulation has been suggested as a means of reducing the risk of thrombus formation on the surface of the embolized MMA material. Although there is no evidence to support this in the literature, when cement emboli
are encountered in an asymptomatic patient they are probably of no clinical significance and have no long-term sequelae.
References
Pelton WM, Kirsch J, Candocia FJ et al. Methylmethacrylate pulmonary emboli : radiographic and computed tomographic findings. J Thorac Imaging 2009;24:241-247
Keywords
vascular, embolic, iatrogenic,

No. of Applicants : 96

▶ Correct Answer : 76/96,  79.2%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Okayama University , Japan Akihiro Tada
  • - Japanese Red Cross Society Himeji Hospital , Japan Yuichiro Kanie
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Doctors Hospital , Bahamas muneesh sharma
  • - University of British Columbia , Canada Amr Ajlan
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - radiologist, aditya imaging centre , India vivek patel
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - NMC, sunder lal jain hospital , India SANJEEV VACHHER
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - Goa Medical College , India Paresh Desai
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - National Jewish Health , United States Jonathan Chung
  • - HSC , Brazil Diogo Pinheiro
  • - CHRU lille , France manuel toledano
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Catholic medical center , Korea (South) hyuna kim
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - KMC,Manipal , India satish maddukuri
  • - Seoul National University Hospital , Korea (South) Hyungjin Kim
  • - DRRPGMC KANGRA AT TANDA , India Dinesh Sood
  • - Montreal , Canada D J
  • - McGill University Health Center , Canada Alexandre Semionov
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Korea university , Korea (South) SUMIN HA
  • - XiangYa , China yu xia
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - Gangnam severance hospital , Korea (South) Sejin Nam
  • - MBAL Sliven , Bulgaria Zlatina Boneva
  • - Gwangju 21st century hospital , Korea (South) Hyungwoo Oh
  • - Jaseng Oriental Hospital , Korea (South) Byung-June Jo
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - GRMC (Gajra raja medical college), deptt. of radiodiagnosis gwalior , India SHAILESH GUPTA
  • - Chonnam national university hospital , Korea (South) Jang-hyeon Song
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - Asan Medical Center , Korea (South) Eun Kim
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Chungnam National University hospital , Korea (South) sunkyoung you
  • - CH de la Cote Basque , France Paul ARDILOUZE
  • - chp st martin , France Mariotte benoit
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Severance hospital , Korea (South) MINA PARK
  • - Chonnam National University Hwasoon Hospital , Korea (South) You Ri Choi
  • - Hallym sacred hospital , Korea (South) BANGSIL Jo
  • - UWO , Canada S Lee
  • - IRSA , France jean-luc BIGOT
  • - Smile Radiologic clinic , Korea (South) Sung-Kyu Choi
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Seoul National University Hospital , Korea (South) Sung Ui Shin
  • - Korea university , Korea (South) Kun Woo Kang
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Kyung Hee University Hospital , Korea (South) Jihye Jang
  • - EKH-Berlin , Germany Michael Weber
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - newmasan hospital , Korea (South) park ji hoon
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - NASA SCANS ROHINI NEW DELHI , India RAKESH BHATIA
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - Montreal Chest Institute , Canada Faiz Kham
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Private sector , Greece Vasilios Tzilas
  • - All India Institute of medical sciences , India Justin Moses
  • - Asan Medical Center , Korea (South) Bohyun Kim
  • - Shree Diagnostics , India amol jagdale
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
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