Cardiac Embolism Followed by Perforation of Right Ventricle after Percutaneous Vertebroplasty

Abstract

The incidence of osteoporotic or neoplastic vertebral compression fractures is increasing. Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral compression fractures. However, bone cement leakage into the paravertebral venous system can rarely lead to systemic complications such as pulmonary embolism and even worse, intracardiac injury. A 49-year-old man was admitted with chest pain and dyspnea. During hemodialysis for end stage renal disease, his blood pressure suddenly dropped and he lost consciousness. He had a history of L5 compression fractures, for which he had undergone PVP at another hospital 4 days ago. Performed all Images showed a rod-shaped high-density material protruding through the right atrium (RA) and right ventricle (RV). Emergency operation was performed for the removal of the foreign body and repair of the ruptured RV wall. A biopsy during the PVP had revealed a metastatic spine lesion originating from renal cell carcinoma as the underlying cause of the fracture. The patient expired 2 months later because of cancer progression. To prevent this complications, a small amount of PMMA (Poly methyl methacrylate) should be injected slowly, and low viscosity PMMA should be avoided.