Cement Embolism

Between 2% and 25% of patients who undergo vertebroplasty develop cement (polymethylmethacrylate) pulmonary emboli. These are usually asymptomatic and go undetected by operator at the time of imaging. Cement leakage into the paravertebral veins and/or inferior vena cava may be associated with development of pulmonary cement embolism. There may also a correlation between the total number of treated levels and the number of emboli.

While most patients are asymptomatic, rare but serious complications can occur. Emboli can be lethal if they lodge in the right atrium or ventricle, leading to cardiac perforation and tamponade. In addition, pulmonary infarction, hypercapnia, and even cardiac arrest have been reported in association with cement emboli.

In addition, patients with already low cardiopulmonary reserve may not tolerate the burden of small peripheral emboli.

Radiographs reveal multiple dense tubular and branching opacities scattered throughout the lungs. CT can show branching or punctate high-attenuation along the expected course of a pulmonary artery. Long cement fragments can also be seen a paravertebral vein with or without extension into the inferior vena cava.

References

• Kim YJ, Lee JW, Park KW, Yeom JS, Jeong HS, Park JM, Kang HS. Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors. Radiology. 2009 Apr;251(1):250-9.
• Luetmer MT, Bartholmai BJ, Rad AE, Kallmes DF. Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. AJNR Am J Neuroradiol. 2011 Apr;32(4):654-7.