Intracardiac cement embolus from vertebroplasty
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Case Summary
A 72-year-old female initially presented to the emergency department with severe low back pain after using her bedside commode at home. Radiographs of the lumbar spine showed age-indeterminate compression deformities of the L1 and L2 vertebral bodies. Subsequent magnetic resonance imaging (MRI) confirmed acuity of the fractures. The patient underwent percutaneous vertebroplasty with polymethyl methacrylate of both L1 and L2, and was later discharged.
The patient was readmitted seven months later, following a fall. Abdominal radiograph showed a nonspecific linear density projecting over the spine (Figure 1). Computed tomography (CT) of the abdomen and pelvis was then performed, and demonstrated a high-attenuation linear structure extending from the mid inferior vena cava (IVC) into the right ventricle (Figure 2). Initially, the finding was thought to represent an abandoned catheter.

Imaging Findings
Upon review of perioperative fluoroscopic images from the patient’s vertebroplasty (not shown), the foreign body was absent prior to, and present after injection of cement material. Closer scrutiny of the CT showed cement extending from a paravertebral vein at the L2 vertebral body into the IVC (Figures 3 and 4), and into the right atrium and ventricle.

Diagnosis
Cement embolus from vertebroplasty
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