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Cho, Jung, Eum, Seo, Jegal, Choi, and Ahn: Numerous Bilateral Radiographically Dense Branching Opacities after Vertebroplasty with Polymethylmethacrylate
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Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 61(2): 184-188.

Published online: 31 August 2006

DOI: https://doi.org/10.4046/trd.2006.61.2.184

Numerous Bilateral Radiographically Dense Branching Opacities after Vertebroplasty with Polymethylmethacrylate

Jun Hyun Cho, M.D., Jong Pil Jung, M.D.1, Jun-Bum Eum, M.D., Kwang Won Seo, M.D., Yang Jin Jegal, M.D., Seong Hoon Choi, M.D.2, Jong Joon Ahn, M.D.

Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

1Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

2Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Address for correspondence: Jong Joon Ahn M.D. Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, 290-3, Jeonha-dong, Dong-ku, Ulsan 682-714 Korea. Phone: 052-250-8870, Fax: 052-251-8235, jjahn@uuh.ulsan.kr

Received 27 June 2006       Accepted 20 July 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Percutaneous vertebroplasty consists of the percutaneous injection of polymethylmethacrylate (PMMA) cement into a collapsed vertebral body in order to obtain pain relief and mechanically strengthen the vertebral body. This procedure is now extensively used in treating osteoporotic vertebral compression fracture. It is an efficient treatment, but it is not free of complications. Most complications after vertebroplasty are associated with PMMA leakage. Pulmonary embolism of PMMA is rare, but this can occur when there is a failure to recognize venous migration of cement early during the procedure. We encountered a case of a patient with asymptomatic pulmonary embolism because of PMMA after percutaneous vertebroplasty. Chest X-ray and CT scanning revealed numerous tubular branching opacities that corresponded to the pulmonary vessels at the segmental and subsegmental levels.

Keywords: Pulmonary embolism, Polymethylmethacrylate, PMMA, Bone cement, Percutaneous vertebroplasty

Figures and Tables

Figure 1
(A) Posteroanterior chest radiograph after vertebroplasty shows numerous bilateral dense branching opacities corresponding to pulmonary vessels at segmental and subsegmental levels. (B) Lateral chest radiograph shows leakage of cement into prevertebral vein (arrow) and epidural space (arrowheads).
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Figure 2
Coronal reformatted computed tomography (CT) image shows radioopaque tubular branching structures (four marked with paired arrows) continued to pulmonary arteries at segmental and subsegmental levels.
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Figure 3
Precontrast axial CT scan shows no cement embolus in large, central pulmonary arteries.
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Figure 4
Sagittal reformatted CT images show leakage of cement into epidural space (arrow in A) prevertebral vein (arrow in B). Calcified lymph nodes in right paratracheal area are noted in B.
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Figure 5
Posteroanterior chest radiograph before thoracic vertebroplasty shows no abnormal parenchymal lesion.
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