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Pulmonary Embolism of Polymethyl Methacrylate During Percutaneous Vertebroplasty and Kyphoplasty

Du Hwan Choe1,2, Edith M. Marom1, Kamran Ahrar1, Mylene T. Truong1 and John E. Madewell1

1 Department of Radiology, Box 57, Division of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.
2 Present address: Department of Radiology, Korea Cancer Center Hospital, Seoul, Korea.



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  		Fig. 1A. —Asymptomatic 53-year-old man with uneventful vertebroplasty for multiple myeloma. Coned view of posteroanterior chest radiograph obtained 3 months after procedure shows small high-density opacity (arrow). Arrowhead marks cement in vertebral body.

 


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  		Fig. 1B. —Asymptomatic 53-year-old man with uneventful vertebroplasty for multiple myeloma. Contrast-enhanced chest CT scan (3.75-mm collimation, bone window settings) shows small cement embolus (straight arrow) in anterior segment of left upper lobe pulmonary artery. Curved arrow marks contrast-enhanced superior vena cava. Arrowhead marks contrast agent in azygos vein.

 


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  		Fig. 2A. —Asymptomatic 48-year-old woman 2 months after uneventful vertebroplasty for multiple myeloma. Posteroanterior chest radiograph shows numerous bilateral radiographically dense tubular branching opacities (three marked with arrows) corresponding to pulmonary vessels at segmental and subsegmental levels. Findings remained stable on follow-up radiographs (not shown) obtained 4 months after A.

 


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  		Fig. 2B. —Asymptomatic 48-year-old woman 2 months after uneventful vertebroplasty for multiple myeloma. Coned view of A shows tubular branching opacities (three marked with arrows).

 


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  		Fig. 3A. —Asymptomatic 58-year-old woman 10 days after uneventful vertebroplasty for multiple myeloma. Unenhanced abdominal CT scan (10-mm collimation) shows cement in treated vertebral body and extravasation (arrowhead) to adjacent soft tissues and into perivertebral vein (arrow), extending into left renal vein.

 


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  		Fig. 3B. —Asymptomatic 58-year-old woman 10 days after uneventful vertebroplasty for multiple myeloma. Coned view of posteroanterior chest radiograph shows cement emboli at segmental and subsegmental levels (two marked with arrows). Arrowhead marks cement in treated vertebral body.

 

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