Cement Embolization to Right Atrium and Pulmonary Artery After Percutaneous Vertebroplasty.

SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters IIPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: This particular complication of vertebroplasty calls for better awareness and care against such complication.METHODS: A 28-year male with 4-year history of ulcerative colitis was maintained on prednisolone, mesalazine and infiximab. He underwent cement vertebroplasty for severe lumbar spine osteoporosis, 24 hours after which he developed right pleuritic pain and dyspnea. Chest X-ray,Echocardiogram, Chest CT-Angiogram and Lab tests were performed.RESULTS: Lab tests: pO2 75mmHg & pCO2 25mmHg, pH 7.48, D-Dimer 5763 elevated (N ~500). Echocardiogram revealed pericardial effusion & echogenic mass in right atrium.Chest X-ray showed high density mass at the right atrium. CT-Angiogram showed high density masses in right atrium & pulmonary artery branches with a pericardial effusion Cardiac temponade necessitated ultrasound guided pericardial drainage and pulsating bloody fluid issued. Emergency cardiac surgery was performed. Cement masses were removed from both right atrium and right pulmonary branches. Tears in tricuspid valve and right atrial wall were repaired. The patient was discharged after one week and at 4-month follow up, he was still in excellent condition.CONCLUSIONS: Cement emboli following vertebroplasty has been reported in 6.8%. However, our case exemplifies dramatic event with right atrial and pulmonary artery involvement, which has not been previously described.CLINICAL IMPLICATIONS: We recommend use of large caliber needles to reduce injection pressure and more barium for better detection of extravasation.DISCLOSURE: The following authors have nothing to disclose: Samir Diab, Mohammad DiabNo Product/Research Disclosure InformationSpecialty Hospital, Amman, Jordan.