Asymptomatic right atrial cement embolism after vertebral kyphoplasty requiring surgical extraction: a case report
Cristian Coso Garrido, Archil Bachiashvili, Celia Denche Sanz, María Jesús López Gude, Christian Muñoz GuijosaAbstract
Background
Intracardiac cement embolism is a rare but potentially life-threatening complication of vertebral augmentation procedures. Management remains controversial, particularly in asymptomatic patients.
Case summary
A 68-year-old man underwent percutaneous vertebral kyphoplasty for compression fractures related to multiple myeloma. Four days later, transthoracic echocardiography performed during the diagnostic work-up for fever incidentally detected a mobile hyperechoic mass within the right atrium. Computed tomography confirmed a 25 × 11 mm intracardiac cement embolus associated with multiple pulmonary cement emboli. Despite the absence of symptoms, surgical extraction was indicated because of the embolus size, marked mobility, and embolic risk. Median sternotomy with cardiopulmonary bypass enabled successful en bloc removal of a cement fragment adherent to the right atrial wall, together with closure of an incidental patent foramen ovale. Residual distal pulmonary cement emboli were managed conservatively with anticoagulation. The postoperative course was uneventful.
Discussion
Intracardiac cement embolism may present incidentally after vertebral augmentation procedures. Multimodality imaging is essential for diagnosis and therapeutic planning. Surgical extraction should be considered in patients with large, mobile, or adherent intracardiac cement emboli because of the risk of embolization and cardiac complications.