Pulmonary Embolism Caused by Acrylic Cement

An axial CT image shows hyperdense structures within the segmental branch of the right middle lobe pulmonary artery (arrow), and in the perivertebral venous plexus (arrowheads). The patient had recent vertebroplasty performed for lumbar back pain.

Facts: Vertebroplasty

• Injection of acrylic cement (polymethylmethacrylate; PMMA) into the diseased vertebral body for partial remodeling and lumbar pain relief
• Infrequent complications such as infection, cement leakage

Facts: Leakage from Vertebroplasty

• Can be into the spinal canal, or perivertebral venous plexuses
• Perivertebral venous leakage can be into the internal venous plexuses (potentially resulting in cord/nerve root compression) or external venous plexuses
• More often if inadequate preparation of PMMA (acrylic cement must be mixed to consistency of paste before injection to ensure advanced polymerization)
• More often if vertebroplasty is performed for vascular lesions (metastasis from thyroid cancer, renal cell carcinoma, vertebral angiomas)

Imaging Findings

• Hyperdense material in the branches of pulmonary arteries with or without evidence of pulmonary infarction
• Hyperdense materials in the perivertebral veins

Reference:

Padovani B, et al. Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJNR 1999; 20:375-377.