Percutaneous Retrieval of an Embolized Kyphoplasty Cement Fragment From the Pulmonary Artery: A Case Report and Literature Review

摘要

We present a case of a 41-year-old man with symptomatic pulmonary cement embolism following percutaneous vertebral augmentation, which was successfully retrieved via a percutaneous endovascular approach, a novel technique with only two prior cases reported. Cement leakage, including venous embolization of cement into the cardiopulmonary circulation, is a known potential complication following percutaneous kyphoplasty and vertebroplasty. While many patients with pulmonary cement embolism are asymptomatic and likely go undiagnosed, others experience respiratory distress and hemodynamic compromise requiring surgical and medical intervention. The optimal management for pulmonary cement embolism must be tailored to fit each individual patient, dependent upon the acuity of the clinical presentation, coexisting patient comorbidities, and the risks of systemic anticoagulation. In our patient, cement migration was visualized in real-time during vertebral augmentation. Endovascular retrieval by our Interventional Radiology section obviated the need for anticoagulation therapy or more invasive open surgical procedures. Keywords: Pulmonary Cement Embolism, Pulmonary Angiogram, Kyphoplasty/Vertebroplasty, Endovascular Retrieval, InterventionCASE REPORTA 41-year-old man with epilepsy presented to our institution for treatment of thoracic compression fractures sustained during a seizure three months prior. The patient continued to experience severe mid-thoracic pain despite conservative treatment. Thoracic MRI at an outside institution (images not available for review) revealed T7 and T8 compression fractures with T2 and STIR signal hyperintensity at the superior endplates, consistent with non-healing. Bone scan, performed to further evaluate fracture status, showed corresponding increased uptake at T7 and T8, indicating metabolically active fractures (Fig. 1a–c). After weighing the risks, benefits and alternatives, decision was made to proceed with kyphoplasty in a young patient with non-healing, symptomatic compression fractures. Open in a separate windowFigure 1 A 41-year-old male patient underwent kyphoplasty for treatment of vertebral body compression fractures complicated by right pulmonary artery cement embolism status post percutaneous endovascular retrieval by Interventional Radiology. (a) Planar posterior left oblique view of the chest, (b) axial SPECT of the chest at the T8 level, and (c) whole body bone scan demonstrate increased uptake in the mid thoracic spine, corresponding to the T7 and T8 vertebral body levels (arrows), indicating metabolically active fractures.Technique: 27mCi Tc-99m MDP IV, obtained 4 hours after injection of radiotracer.