Foreign-Body Pulmonary Embolism

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Arch Bronconeumol. 2014;50(3):123
www.archbronconeumol.org
Clinical Image
Foreign-Body Pulmonary Embolism夽
Embolismo pulmonar por cuerpo extraño
Aaron Cordova, Inmaculada Alfageme∗
Unidad de Gestión Clínica de Neumología, Hospital Universitario Virgen de Valme, Sevilla, Spain
A fifty-year-old woman, never smoker, with an L5 vertebroplasty performed four years previously was referred to our
unit because of a radiographic finding. The patient had had
dyspnea on heavy exertion for four years, episodes of chest
tightness and palpitations. Physical examination was normal. CT
images revealed a calcific density foreign body in the left pulmonary artery and similar smaller masses in the right chest.
A leakage of vertebral cement could be observed at the level
of the L5 vertebra, communicating with the left common iliac
vein.
The patient was diagnosed with pulmonary embolism (PE)
of polymethyl methacrylate (PMMA), a material used as cement
in vertebroplasty. Cement leakage to peripheral tissues during the procedure is the most common complication. PE
occurs in 3.4–23% of vertebroplasties performed for osteoporotic
fractures,1 and is asymptomatic in most cases. Immediate postoperative management of PE is based on the presence of
symptoms and the location of the embolization. Observation is
recommended in asymptomatic cases, 3–6 months of anticoagulation therapy is recommended in symptomatic cases and in
those with central emboli, and surgery is required in severe
cases.
In our case, the surgery was old, so we decided treatment unnecessary and but to monitor the patient periodically. No clinical
changes have been observed in 3 years of follow-up.
Reference
1. Krueger A, Bliemel C, Zettl R, Ruchholtz S. Management of pulmonary cement
embolism after percutaneous vertebroplasty and kyphoplasty: a systematic
review of the literature. Eur Spine J. 2009;18:1257–65.
夽 Please cite this article as: Cordova A, Alfageme I. Embolismo pulmonar por
cuerpo extraño. Arch Bronconeumol. 2014;50:123.
∗ Corresponding author.
E-mail address: ialfageme@separ.es (I. Alfageme).
1579-2129/$ – see front matter © 2013 SEPAR. Published by Elsevier España, S.L. All rights reserved.