Late Manifestation of Pulmonary Cement Embolism Visualized by Coronary Angiography

Key words: cardiac imaging, coronary angiography

A 75-year-old female patient was admitted to the cardiology clinics with exertional dyspnea during daily activity. She had a history of diabetes mellitus and hypertension. Transthoracic echocardiography revealed normal ejection fraction, mild tricuspid regurgitation, and pulmonary hypertension (systolic pulmonary arterial pressure, 42 mm Hg). Coronary angiography was performed to rule out coronary artery disease. No significant lesion was found in the coronary arteries. However, some lesions were observed in the lungs during visualization of the coronary arteries. Based on the patient’s history and medical record, she had undergone percutaneous vertebroplasty for vertebral compression fracture 6 years prior. Following operation, pulmonary cement embolism had been developed due to the leakage of polymethylmethacrylate cement into the paravertebral venous plexus. Lesions seen on the lung area were interpreted as the late manifestation of the aforementioned complication (Figure 1A, white arrows; Video 1). Percutaneous vertebroplasty implemented vertebrae were also visualized by another coronary angiographic view demonstrating orthopedic surgical history of the patient (Figure 1B, black arrows; Video 2). After the coronary angiography, she was referred to pulmonary medicine department for further treatment.

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From the ¹Department of  Cardiology and ²Department of  Orthopedics and Traumatology, Istanbul Yeni Yuzyil University, Faculty of Medicine, Gaziosmanpasa Hospital,  Gaziosmanpasa, Istanbul, Turkey.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted March 28, 2019.

Address for correspondence: Ali Dogan, MD, Cardiologist, Istanbul Yeni Yuzyil University, Faculty of Medicine, Gaziosmanpasa Hospital, Cardiology Department, Gaziosmanpasa, Istanbul, Turkey. Email: drdali@hotmail.com.