Thorned heart. Description of a near-fatal cardiac embolism after percutaneous Vertebroplasty

  • Federica Pigna Emergency Department, University Hospital of Parma, Italy.
  • Simone Calamai Postgraduate Emergency Medicine School, University of Parma, Italy.
  • Francesco Scioscioli Emergency Department, University Hospital of Parma, Italy.
  • Lorenzo Buttarelli Department of Radiology, University Hospital of Parma, Italy.
  • Francesco Nicolini Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy.
  • Gianfranco Cervellin | gianfranco.cervellin@gmail.com Academy of Emergency Medicine and Care (AcEMC), Pavia, Italy.

Abstract

Cement extravasation is a rather common complication of vertebroplasty, which can be observed in up to 30-40% of patients undergoing this procedure, further associated with venous leakage occurring in up to 24% of cases. Pulmonary embolism may eventually develop once the cement migrates within the pulmonary artery, and is the most common complication of cement extravasation (involving ~4.6% of patients). Intra-cardiac cement embolism is considerably less frequent, but is a potentially fatal complication, mostly managed with cardiac surgery. We describe here a rare case of near-fatal cardiac cement embolism, with a large fragment perforating the right ventricle and reaching the pericardium, who presented to the Emergency Department (ED) for syncope. The patient, who displayed this severe complication after a vertebroplasty procedure performed for osteoporotic compression fracture, needed cardiac surgery.

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Published
2020-05-06
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Issue
Section
Case Reports
Keywords:
vertebroplasty, cardiac embolism, osteoporotic compression fractures, acrylic cement extravasation
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How to Cite
Pigna, F., Calamai, S., Scioscioli, F., Buttarelli, L., Nicolini, F., & Cervellin, G. (2020). Thorned heart. Description of a near-fatal cardiac embolism after percutaneous Vertebroplasty. Emergency Care Journal, 16(1). https://doi.org/10.4081/ecj.2020.8739