J Korean Soc Radiol.  2014 Jun;70(6):419-422. 10.3348/jksr.2014.70.6.419.

Multidetector CT Findings of Polymethylmethacrylate Cement Leakage Inducing Inferior Vena Cava Thrombosis: A Case Report

• Hwang Y
• Ku YM
• Lee SL

• KMID: 1941769
• DOI: http://doi.org/10.3348/jksr.2014.70.6.419

Abstract

Although percutaneous vertebroplasty is a relatively safe procedure, cement leakage into the spinal canal and paravertebral veins may occur. Most patients with cement leakage are asymptomatic. However, it can result in spinal cord compression or pulmonary embolism. Cement-induced thrombosis in the inferior vena cava is a very rare complication of percutaneous vertebroplasty, with only few reports in the literature. We report a case of cement leakage-induced thrombosis in the inferior vena cava in a 72-year-old woman, focusing on multidetector CT findings. On contrast-enhanced CT scan, a persistent hypodense filling defect in the opacified lumen of the inferior vena cava combined with a high density cement cast adjacent to the vertebroplasty area were helpful imaging findings in making the diagnosis of bone cement leakage-induced thrombosis in the inferior vena cava.

MeSH Terms

Aged
Diagnosis
Female
Humans
Polymethyl Methacrylate*
Pulmonary Embolism
Spinal Canal
Spinal Cord Compression
Thrombosis*
Tomography, X-Ray Computed
Veins
Vena Cava, Inferior*
Vertebroplasty
Polymethyl Methacrylate

Figure

• 

  Fig. 1 A 72-year-old woman with polymethylmethacrylate cement-leakage-induced thrombosis in the inferior vena cava (IVC). A, B. Axial contrast-enhanced CT images show a linear high density lesion (black arrowhead in A) in the IVC at the level of L4 vertebral body, which has continuity with the cement-injected L4 vertebral body through the paravertebral venous plexus (white arrowhead in B). C. Coronal reformatted image demonstrates long segmental persistent filling defect (long arrow) in the IVC, suggesting thrombosis. The proximal portion of the thrombosis abutting linear high density lesion (white arrowhead) suggests bone cement-leakage-induced thrombosis formation. D. Inferior vena cavography shows intraluminal filling defect (black arrowhead) in the IVC, suggesting IVC thrombosis, and IVC filter (black arrow) is inserted in the suprarenal IVC to prevent pulmonary embolism.

Reference

1. Galibert P, Deramond H, Rosat P, Le Gars D. [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. Neurochirurgie. 1987; 33:166–168.

2. Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol. 1997; 18:1897–1904.

3. Kim SM, Min SK, Jae HJ, Min SI, Ha J, Kim SJ. Successful thrombolysis, angioplasty, and stenting of delayed thrombosis in the vena cava following percutaneous vertebroplasty with polymethylmethacrylate cement. J Vasc Surg. 2012; 56:1119–1123.

4. Kao FC, Tu YK, Lai PL, Yu SW, Yen CY, Chou MC. Inferior vena cava syndrome following percutaneous vertebroplasty with polymethylmethacrylate. Spine (Phila Pa 1976). 2008; 33:E329–EE33.

5. Athreya S, Mathias N, Rogers P, Edwards R. Retrieval of cement embolus from inferior vena cava after percutaneous vertebroplasty. Cardiovasc Intervent Radiol. 2009; 32:817–819.

6. Agko M, Nazzal M, Jamil T, Castillo-Sang M, Clark P, Kasper G. Prevention of cardiopulmonary embolization of polymethylmethacrylate cement fragment after kyphoplasty with insertion of inferior vena cava filter. J Vasc Surg. 2010; 51:210–213.

7. Yoo KY, Jeong SW, Yoon W, Lee J. Acute respiratory distress syndrome associated with pulmonary cement embolism following percutaneous vertebroplasty with polymethylmethacrylate. Spine (Phila Pa 1976). 2004; 29:E294–E297.

8. Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD. Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors. Spine J. 2011; 11:839–848.

9. Kaufman LB, Yeh BM, Breiman RS, Joe BN, Qayyum A, Coakley FV. Inferior vena cava filling defects on CT and MRI. AJR Am J Roentgenol. 2005; 185:717–726.

10. Ware JA, Kang J, DeCenzo MT, Smith M, Watkins SC, Slayter HS, et al. Platelet activation by a synthetic hydrophobic polymer, polymethylmethacrylate. Blood. 1991; 78:1713–1721.