Images in Clinical Rheumatology
Asymptomatic pulmonary embolism secondary to cement leakage after vertebroplasty
Embolismo pulmonar asintomático secundario a fuga de cemento tras vertebroplastia
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As mentioned by the patient, the procedure was performed without complications and from it she achieved partial improvement of pain. On questioning she denied any respiratory symptoms. On physical examination the vital signs were normal, with 99% ambient air oxygen saturation. In the thoracic assessment the heart sounds were rhythmic, without murmurs, and the lung fields were not altered. Lumbar spine ranges of motion were diminished and there was pain on active and passive movement. Lumbar spine radiography showed scoliosis, as well as volume loss and the presence of radiopaque material at L3 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Chest radiography showed the presence of radio-opaque material in right-dominant pulmonary vascular distribution (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Vertebral fracture is the most common complication of osteoporosis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> In some patients vertebroplasty is used to reduce pain.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> This procedure involves the injection of cement to stabilise the anterior spine. Leakage of material has been reported in 30%–65% of patients. The risk factors described for this complication are: intravertebral fissure, cortical disruption and procedure-related factors (viscosity of the cement and volume of cement injected).<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a> It is considered that overfill of the vertebral body or inadvertent puncture into the radiated veins will facilitate the migration of cement into the perivertebral venous plexus, to pass through the hemiazygous vein, the azygous vein and flow into the inferior vena cava, which is where polymerisation of the material and embolism will occur.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Most patients have reported asymptomatic side effects. In cases of pulmonary embolism, it has been reported that 26% will be asymptomatic<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> and in <1% of cases will present some symptoms.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6,7</span></a> The patient was sent to rehabilitation and treated with analgesics, with a good short-term outcome.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare and the patient was asked for their consent to use the images.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-07-19" "fechaAceptado" => "2019-11-25" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arana-Guajardo AC, Levi Cavazos-Aranda A. Embolismo pulmonar asintomático secundario a fuga de cemento tras vertebroplastia. Reumatol Clin. 2021;17:302–303.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1800 "Ancho" => 1500 "Tamanyo" => 279600 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anterior–posterior lumbar spine radiograph.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1303 "Ancho" => 1500 "Tamanyo" => 145881 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Postero-anterior chest X-ray.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risks and benefits of percutaneous vertebroplasty or kyphoplasty in the management of osteoporotic vertebral fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 12 | 21 |
| 2024 October | 48 | 22 | 70 |
| 2024 September | 44 | 12 | 56 |
| 2024 August | 65 | 25 | 90 |
| 2024 July | 44 | 14 | 58 |
| 2024 June | 60 | 26 | 86 |
| 2024 May | 70 | 21 | 91 |
| 2024 April | 66 | 27 | 93 |
| 2024 March | 76 | 23 | 99 |
| 2024 February | 72 | 27 | 99 |
| 2024 January | 71 | 27 | 98 |
| 2023 December | 31 | 24 | 55 |
| 2023 November | 50 | 28 | 78 |
| 2023 October | 62 | 29 | 91 |
| 2023 September | 72 | 34 | 106 |
| 2023 August | 65 | 17 | 82 |
| 2023 July | 62 | 23 | 85 |
| 2023 June | 43 | 32 | 75 |
| 2023 May | 65 | 28 | 93 |
| 2023 April | 80 | 20 | 100 |
| 2023 March | 144 | 33 | 177 |
| 2023 February | 147 | 28 | 175 |
| 2023 January | 128 | 18 | 146 |
| 2022 December | 137 | 39 | 176 |
| 2022 November | 160 | 41 | 201 |
| 2022 October | 178 | 30 | 208 |
| 2022 September | 115 | 27 | 142 |
| 2022 August | 93 | 42 | 135 |
| 2022 July | 103 | 44 | 147 |
| 2022 June | 137 | 31 | 168 |
| 2022 May | 108 | 41 | 149 |
| 2022 April | 117 | 48 | 165 |
| 2022 March | 37 | 50 | 87 |
| 2022 February | 34 | 30 | 64 |
| 2022 January | 39 | 31 | 70 |
| 2021 December | 35 | 46 | 81 |
| 2021 November | 39 | 48 | 87 |
| 2021 October | 5 | 4 | 9 |
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