Answer: A. Cement Emboli
Discussion
Cement emboli are seen in these imaging modalities, as pointed out by
the blue arrows. These radiopaque densities involve the distal
pulmonary arteries and is related to the patient’s recent
vertebroplasty. Vertebroplasties are performed to restore height,
stabilize bony trabeculae, and alleviate pain. During a vertebroplasty,
polymethyl methacrylate (a cement compound) is introduced into the
vertebral body. Rarely, it extravasates into the vertebral venous plexus
and migrates into the IVC and pulmonary arterial system. Based on
literature review, 0.4-0.9% of patients who undergo vertebroplasties are
found to have cement emboli. This can present as dyspnea, tachycardia,
and/or tachypnea. Even though there have been a limited number of cases
involving this complication, onset of symptoms ranged from ages 15 to 96
and involved approximately 65% females and 35% males. Many times
patients present with acute onset dyspnea and chest pain. Risk factors
were not identified.
Cement emboli can be diagnosed with plain films. On CT scan, cement
emboli are differentiated from thrombi by diameter, length, caliber, and
radio-opacity. Based on limited case reports, it is thought that the
treatment of cement emboli should include anticoagulation. Warfarin or
enoxaparin for approximately three months can be used and helps prevent
thrombosis around the cement.
References
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Rahimi B, Boroofeh B, Dinparastisaleh R, et. al. Cement pulmonary
embolism after percutaneous vertebroplasty in a patient with cushing's
syndrome: A case report. Respir Med Case Rep 2018; 25: 78–85.
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Oshinsky C, Bhavani S, Funaki A. Cement cardiac embolism following kyphoplasty noted on thoracic imaging. Radiol Case Rep 2018; 13(4): 914–6.
- Siddiqui AS, Goodarzi A, Majumdar T, et. al. A rare case of pulmonary cement embolism in a lung transplant patient. Respir Med Case Rep 2018; 24: 63–4.
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Bernhard J, Heini PF, Villiger PM. Asymptomatic diffuse pulmonary
embolism caused by acrylic cement: an unusual complication of
percutaneous vertebroplasty. Ann Rheum Dis 2003; 62(1):85–6.
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Duijvelshoff R, Anthonissen NFM, Morshuis WJ, et. al. Intracardiac cement embolism resulting in tricuspid regurgitation. European Journal of Cardio-Thoracic Surgery 2019; 55(2): 366–8.
