SHM Converge Scientific Abstract ePoster Gallery-A Heart of Cement: Unexpected Kyphoplasty Consequences

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This case report describes a rare but serious complication of kyphoplasty/vertebroplasty: cement embolization into the venous system and heart. A 55-year-old woman underwent kyphoplasty for a T12 fracture and soon developed severe interscapular pain and exertional shortness of breath. Imaging at an outside hospital and again at the treating institution showed a long cement embolus extending from the azygos vein through the superior vena cava into the right atrium, right ventricle, and pulmonary trunk. TEE also revealed right-sided chamber dilation, mild tricuspid regurgitation, and a small pericardial effusion.<br /><br />Because of the size and location of the cement and concern for fracture, distal embolization, valve damage, infection, and pulmonary complications, the team chose open surgical removal rather than percutaneous retrieval. The patient underwent median sternotomy and cardiopulmonary bypass, and four cement fragments were removed from the heart and pulmonary trunk. A cement fragment remaining in the azygos vein was not retrievable and was seen on postoperative imaging. Her recovery was otherwise uneventful.<br /><br />The discussion emphasizes that cement embolization after vertebroplasty or kyphoplasty can be asymptomatic or cause chest pain, dyspnea, heart failure, tamponade, or death. CT is the preferred diagnostic test. While anticoagulation is often used for several months in some cases, there are no standardized management guidelines. The report highlights risk factors such as venous needle placement, high injection pressure, low-viscosity PMMA, and multilevel procedures. It concludes that patients with intracardiac cement emboli should be managed at centers capable of surgical removal when necessary.

Asset Subtitle

Talal Alomar

Meta Tag

Author List Anthony Yeung, Deepti Boddupalli, Kevin Brady, Ramandeep Sandhu, Ranjani Behara, Sammy Alomar, Talal Alomar, Wali Zaidi

Category Clinical Vignettes

Concept Vertebroplasty

Concept Vertebral kyphoplasty

Concept Cement Embolization

Concept Intracardiac Embolization

Concept Chest Computed Tomography

Distinguished Non-Finalist

Presenter Organization Ucla

Presenting Author Talal Alomar

Track Adult

Keywords

kyphoplasty

vertebroplasty

cement embolization

intracardiac embolus

azygos vein

superior vena cava

right atrium

right ventricle

pulmonary trunk

surgical removal

Vertebroplasty

Vertebral kyphoplasty

Cement Embolization

Intracardiac Embolization

Chest Computed Tomography