대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 868 Date 2014-06-16

  • Courtesy of Song Soo Kim / Chungnam National University College of Medicine
  • Age/Sex 70 / F
  • Chief ComplaintDyspnea for 2 weeks
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pulmonary thromboembolism caused by bone cement emboli
Radiologic Findings
Chest PA shows tiny calcific foci in right hilar area. High densiy is noted in thoracic vertebrae due to previous vertebroplasty. Contrast enhanced CT images show intraluminal thrombus mixed with high attenuating foci in pulmonary trunk and both main and interlobar pulmonary arteries.
Noncontrast CT images(below) show hairpin appearance of high attenuated linear opacties in azygos vein, superior vena vava, right atrium, and right ventricle, and pulmonary arteries.
Brief Review
Pulmonary thromboembolism caused by bone cement emboli after percutaneous vertebroplaty
1. Mostly caused by polymethylmethacrylate (PMMA)
- still too liquid or by applying too much pressure while injection
2.Pathophysiology
A.Percutaneous vertebroplasty (PV) is an interventional radiologic procedure that involves injection of acrylic bone cement into a diseased vertebral body under fluoroscopic or CT guidance.
B.The method was first described by Galibert in 1987 and has since become a standard treatment for osteoporotic vertebral compression fractures and osteolytic vertebral tumours.
C.Because the cement is injected into the vertebral body under high pressure there is a high risk of it entering the perivertebral venous plexus (segmental vein), vena cava and eventually into the pulmonary arteries.
D.It may also induce a local inflammatory reaction at the vessel wall, leading to superimposed thrombosis on the surface of the cement and propagation of a thrombus down into the pulmonary tree.
References
1. Kaufmann TJ et al. A technique to circumvent subcutaneous cement tracts during percutaneous vertebroplasty. AJNR 2004;25:1595-1596
Keywords
Vascular, Embolic, Thromboembolic,

No. of Applicants : 96

▶ Correct Answer : 35/96,  36.5%
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - University of British Columbia , Canada Amr Ajlan
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - university of montreal , Canada Andrei Gorgos I
  • - Scans world , India Philson Mukkada
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - chp st martin , France Mariotte benoit
  • - Soonchunhyang University Seoul Hospital , Korea (South) EUNSUN OH
  • - 異⑸ , Korea (South) Yunhee Jang
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - GHICL , France manuel toledano
  • - Korea university anam hospital , Korea (South) Sung-Hye You
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - McGill University Health Center , Canada Alexandre Semionov
  • - HUEC , Brazil Diogo Pinheiro
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - CHU Poitiers , France CHAN paul
  • - National Hospital Organization Okinawa Hospital , Japan Yasuji Oshiro
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - IRSA La Rochelle , France Denis Chabassiere
  • - chungbuk national university hospital , Korea (South) jeehye kim
  • - Chungbuk univertisy hospital , Korea (South) Soohyun Lee
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Niigata University , Japan Atsushi Uehara
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Japanese national center hospital of neurology and psychiatry , Japan Kaoru Sumida
  • - 異⑸ , Korea (South) Junghwan Kim
  • - CLCC Rennes , France nicolas gautier
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Centre d , Switzerland Louis Locatelli
  • - Medicheck health care , Korea (South) Chae Lim
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - The University of Tokyo Hospital , Japan Takana Yamakawa
▶ Correct Answer as Differential Diagnosis : 19/96,  19.8%
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - UWO , Canada S Lee
  • - kantohrohsai hospital , Japan yoshie sato
  • - Kanto Rosai Hospital , Japan tomoko sako
  • - Jichi Medical University Hospital , Japan Yuichiro Kawahara
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - GTHTM , India srinivasan vrn
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
  • - Chungbuk national university , Korea (South) Yong Kim
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
  • - ICD,MCH CALICUT , India rikhy krishnan
  • - Centre Imagerie de Fribourg , Switzerland Benoit Rizk
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - CNUH , Korea (South) Kim Soo Hyun
  • - Private sector , Greece Vasilios Tzilas
▶ Semi-Correct Answer : 33/96,  34.4%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - radiologist, aditya imaging centre , India vivek patel
  • - i.r.c.c.s.istituto scientifico romagnolo per lo studio e cura dei tumori , Italy Alice Rossi
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Khoo Teck Phuat Hospital Singapore , Singapore ashish chawla
  • - , Korea (South) Choi Seul-Gi
  • - SS ASTHMA AND ALLERGY CENTRE , India SUDHAKAR R
  • - MBAL Chernomorska , Bulgaria VLADISLAV RUSINOV
  • - barnard institute or radiology , India karnan sudha
  • - Royal Perth Hospital , Australia Yuranga Weerakkody
  • - , Korea (South) Chan Park
  • - Hallym University Kangnam Sacred Heart Hospital , Korea (South) Jung Youn Kim
  • - Chonnam national university hospital , Korea (South) INSOO JANG
  • - SALMAN IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Saint Malo , France jean-baptiste Noel
  • - kasturba medical college , India mugil varman
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Chonnam university hospital , Korea (South) Jang mi Baek
  • - Pamukkale University, School of Medicine, Dept. of Radiology , Turkey Nevzat Karabulut
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India sivaraja
  • - TIRUPUR CHEST HOSPITAL , India bommusamy naicker
  • - GOLD child and chest clinic tirunelvelli , India saravanan m
  • - Severance hospital , Korea (South) Bio Joo
  • - privato , Italy genchi enzo
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - NASA SCANS , India RAKESH BHATIA
  • - Fukuyama City Hospital , Japan Mayu Uka
  • - Onomichi municipal hospital , Japan Toshiyuki Komaki
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