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Spine (Phila Pa 1976). 2012 Mar 15;37(6):E411-3. doi: 10.1097/BRS.0b013e318230db1b.

Fatal pulmonary embolism: when the cause is not a thrombus.

Author information

1
Cardiology Division, Internal Medicine Department, Ospedale Civico di Chivasso (Turin), Italy.

Abstract

STUDY DESIGN:

We report a case of pulmonary embolism of polymethylmethacrylate material after percutaneous vertebroplasty.

OBJECTIVE:

To describe a severe vertebroplasty complication, the pulmonary embolism, which proved to be fatal in a patient with many chronic disabilities.

SUMMARY OF BACKGROUND DATA:

Until 2007, the literature noted that the risk of embolism of polymethylmethacrylate after a percutaneous vertebroplasty counted a small number of pulmonary cement embolism and a smaller number of fatal consequences. The most recent research revealed that the risk of a pulmonary cement embolism ranges from 3.5% to 23% for osteoporotic compression fractures.

METHODS:

This study is a case report of an 80-year-old patient with multiple medical comorbid factors, chronic obstructive pulmonary disease, mild renal failure, osteoporosis, and hepatic cirrhosis. Symptoms of pulmonary embolism developed 1 month after a percutaneous vertebroplasty. An echocardiography report suggested that the cement infiltrated the right atrium and the right pulmonary artery, and this was confirmed by a computed tomographic scan. As the therapy with oxygen and low-molecular-weight heparin failed to solve the thrombus, the patient required a surgical tricuspid annuloplasty and the extirpation of the right atrial and right pulmonary masses.

RESULTS:

The course of the operation was complicated by pulmonary infection, and the patient ultimately succumbed to infection/respiratory failure.

CONCLUSION:

The presence of intravascular/intracardiac foreign bodies is underreported in literature, but it is quite common in clinical practice. We need to discuss the choice of some non-risk-free interventions such as vertebroplasty in older patients already affected by multiple main disabilities.

PMID:
22422441
DOI:
10.1097/BRS.0b013e318230db1b
[Indexed for MEDLINE]

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