Produção Nacional
Revisado por pares
Cardiac Embolization of Polymethylmethacrylate after Thoracolumbar Spinal Arthrodesis
2021; Radiological Society of North America; Volume: 3; Issue: 5 Linguagem: Inglês
10.1148/ryct.2021210125
ISSN2638-6135
AutoresLucas de Pádua Gomes de Farias, Ivo Richter, Amanda Rennó El Mouallem, Luciana de Pádua Silva Baptista,
Tópico(s)Spine and Intervertebral Disc Pathology
ResumoHomeRadiology: Cardiothoracic ImagingVol. 3, No. 5 PreviousNext Images in Cardiothoracic ImagingFree AccessCardiac Embolization of Polymethylmethacrylate after Thoracolumbar Spinal ArthrodesisLucas de Pádua Gomes de Farias , Ivo Richter, Amanda Rennó El Mouallem, Luciana de Pádua Silva BaptistaLucas de Pádua Gomes de Farias , Ivo Richter, Amanda Rennó El Mouallem, Luciana de Pádua Silva BaptistaAuthor AffiliationsFrom the UnitedHealth Group, Hospital Samaritano Paulista, Avenida Brigadeiro Luís Antônio, 1895-Bela Vista, São Paulo/SP, CEP 01317-002.Address correspondence to L.d.P.G.d.F. (e-mail: [email protected]).Lucas de Pádua Gomes de Farias Ivo RichterAmanda Rennó El MouallemLuciana de Pádua Silva BaptistaPublished Online:Sep 30 2021https://doi.org/10.1148/ryct.2021210125MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail A 67-year-old woman presented with respiratory symptoms after thoracolumbar spinal arthrodesis. Noncontrast chest CT scans showed a hyperattenuating linear object in the right ventricle and right atrium (Figure, A, B), which was confirmed as an intracavitary hyperechoic line (Figure, C) extending across the tricuspid valve. Contrast-enhanced CT of the lumbar spine showed material with attenuation in the vertebral body of the third lumbar vertebra, the vertebral venous plexus, and inferior vena cava (IVC) (Figure, D). Imaging findings were suggestive of polymethylmethacrylate embolization. Incision of the right atrial wall (Figure, E) revealed the linear polymethylmethacrylate embolus projecting through the tricuspid valve. The patient recovered uneventfully after.Images in a 67-year-old female patient with dyspnea and oxygen desaturation in the immediate postoperative period of thoracolumbar spinal arthrodesis. Images from CT (A, axial oblique multiplanar reformation; B, D, three-dimensional reconstructions) and (C) transthoracic echocardiography show hyperattenuating or hyperechogenic linear material inside the right cardiac chambers (black arrow in A-C) with more similar linear material along with posterior thoracolumbar arthrodesis, following the vertebral venous plexus (white arrow) and then to the inferior vena cava (IVC). (E) Surgical removal with median transsternal incision and extracorporeal circulation shows elongated white material (black arrow) after right atrium (RA) opening (arrowhead), about 10 cm long, projecting to the right ventricle (RV) through the tricuspid valve (*). LV = left ventricle.Download as PowerPointOpen in Image Viewer Polymethylmethacrylate-augmented fenestrated pedicle screw is regarded as an important technique to enhance pedicle screw strength in osteoporotic bones, but it bears a risk of cement leakage into epidural veins and then to the IVC, potentially causing cement embolism to the right heart chambers and pulmonary arteries, which is facilitated due to the valveless vertebral venous plexus (1,2). Leakage risk is also related to cement viscosity and technical aspects of its application (2). Whereas the incidence of pulmonary cement embolism varies from 7.9% to 23%, it is usually not recognized by the operator during the lateral fluoroscopy, and many patients remain asymptomatic with no clinical consequence, being found incidentally on imaging as multiple dense opacities with a tubular or branching shape that are scattered sporadically or distributed diffusely throughout the lungs, right heart chambers, veins, and arteries (2–4). However, a growing number of reports list symptoms ranging from chest pain to fatal cardiopulmonary complications (4).Disclosures of Conflicts of Interest: L.d.P.G.d.F. disclosed no relevant relationships. I.R. disclosed no relevant relationships. A.R.E.M. disclosed no relevant relationships. L.d.P.S.B. disclosed no relevant relationships.Keywords: Conventional Radiography, CT, Intraoperative, Cardiac, Heart, Lung, Right Atrium, Right Ventricle, Vena Cava, Embolism/ThrombosisAuthors declared no funding for this work.References1. Ulusoy OL, Kahraman S, Karalok I et al. Pulmonary cement embolism following cement-augmented fenestrated pedicle screw fixation in adult spinal deformity patients with severe osteoporosis (analysis of 2978 fenestrated screws). Eur Spine J 2018;27(9):2348–2356. Crossref, Medline, Google Scholar2. Janssen I, Ryang YM, Gempt J et al. Risk of cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine. Spine J 2017;17(6):837–844. Crossref, Medline, Google Scholar3. Luetmer MT, Bartholmai BJ, Rad AE, Kallmes DF. Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. AJNR Am J Neuroradiol 2011;32(4):654–657. Crossref, Medline, Google Scholar4. Kim YJ, Lee JW, Park KW et al. Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors. Radiology 2009;251(1):250–259. Link, Google ScholarArticle HistoryReceived: Apr 29 2021Revision requested: June 21 2021Revision received: Aug 16 2021Accepted: Aug 31 2021Published online: Sept 30 2021 FiguresReferencesRelatedDetailsRecommended Articles Fetal Cardiac US: Techniques and Normal Anatomy Correlated with Adult CT and MR ImagingRadioGraphics2017Volume: 37Issue: 4pp. 1290-1303Septal Atrioventricular Junction Region: Comprehensive Imaging in AdultsRadioGraphics2016Volume: 36Issue: 7pp. 1966-1986Accuracy of Non–Electrocardiographically Gated Thoracic CT Angiography for Right Atrial and Right Ventricular EnlargementRadiology: Cardiothoracic Imaging2019Volume: 1Issue: 4Cardiac CT Angiography in Carcinoid Heart DiseaseRadiology2018Volume: 290Issue: 1pp. 32Multimodality Imaging of Transposition of the Great ArteriesRadioGraphics2021Volume: 41Issue: 2pp. 338-360See More RSNA Education Exhibits A Beginner's Guide to Understanding Echocardiography with CT/MRI Correlation, Case-based Examples, and Emphasis on Blind SpotsDigital Posters2019The Puzzle of Describing Congenital Heart Disease: Recognizing the Individual Pieces and Connecting Them Together using Anderson's Sequential Segmental AnalysisDigital Posters2019Multimodality Imaging of Right Atrium: Potential Entities and Radiological Findings Digital Posters2019 RSNA Case Collection Intravenous LeiomyomatosisRSNA Case Collection2020Partial anomalous pulmonary venous returnRSNA Case Collection2021Cardiac MyxomaRSNA Case Collection2020 Vol. 3, No. 5 Metrics Downloaded 149 times Altmetric Score
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