Abstract
Pulmonary bone cement embolism (PCE) is an uncommon event occurring after implantation of polymethylmethacrylate (PMMA) in orthopaedic surgeries involving adult patients, more so in the elderly. Its incidence in the paediatric population is extremely rare. We herein describe a case of PCE in a 15-year-old girl, 9 days after she underwent total elbow replacement with PMMA placement for a primitive neuroectodermal tumour (PNET) of the distal humerus. This report describes the occurrence of a common post-operative complication of bone cement embolism in an uncommon scenario of total elbow replacement for a bone tumour in a child, which masqueraded initially as acute pneumonitis.
Similar content being viewed by others
References
Wang LJ, Yang HL, Shi YX, Jiang WM, Chen L. Pulmonary cement embolism associated with percutaneous vertebroplasty or kyphoplasty: a systematic review. Orthop Surg. 2012;4(3):182–9.
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(9):1257–65.
Venmans A, Lohle PN, van Rooij WJ, Verhaar HJ, Mali WP. Frequency and outcome of pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2008;29(10):1983–5.
Choe DH, Marom EM, Ahrar K, Truong MT, Madewell JE. Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty. AJR Am J Roentgenol. 2004;183(4):1097–102.
Duran C, Sirvanci M, Aydogan M, Ozturk E, Ozturk C, Akman C. Pulmonary cement embolism: a complication of percutaneous vertebroplasty. Acta Radiol. 2007;48(8):854–9.
Venmans A, Klazen CA, Lohle PN, van Rooij WJ, Verhaar HJ, de Vries J, et al. Percutaneous vertebroplasty and pulmonary cement embolism: results from VERTOS II. AJNR Am J Neuroradiol. 2010;31(8):1451–3.
Kim YJ, Lee JW, Park KW, Yeom JS, Jeong HS, Park JM, et al. Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors. Radiology. 2009;251(1):250–9.
Tryba M, Linde I, Voshage G, Zenz M. Histamine release and cardiovascular reactions to implantation of bone cement during total hip replacement. Anaesthesist. 1991;40(1):25–32.
Sabuncuoglu H, Dincer D, Guclu B, Erdogan E, Hatipoglu HG, Ozdogan S, et al. Intradural cement leakage: a rare complication of percutaneous vertebroplasty. Acta Neurochir. 2008;150(8):811–5.
Harrington KD. Major neurological complications following percutaneous vertebroplasty with polymethylmethacrylate: a case report. J Bone Joint Surg Am. 2001;83-A(7):1070–3.
Athreya S, Mathias N, Rogers P, Edwards R. Retrieval of cement embolus from inferior vena cava after percutaneous vertebroplasty. Cardiovasc Intervent Radiol. 2009;32(4):817–9.
Chung SE, Lee SH, Kim TH, Yoo KH, Jo BJ. Renal cement embolism during percutaneous vertebroplasty. Eur Spine J. 2006;15 Suppl 5:590–4.
Yoo KY, Jeong SW, Yoon W, Lee J. Acute respiratory distress syndrome associated with pulmonary cement embolism following percutaneous vertebroplasty with polymethylmethacrylate. Spine. 2004;29(14):E294–7.
Franco E, Frea S, Solaro C, Conti V, Pinneri F. Fatal pulmonary embolism: when the cause is not a thrombus. Spine. 2012;37(6):E411–3.
Tozzi P, Abdelmoumene Y, Corno AF, Gersbach PA, Hoogewoud HM, von Segesser LK. Management of pulmonary embolism during acrylic vertebroplasty. Ann Thorac Surg. 2002;74(5):1706–8.
Habib N, Maniatis T, Ahmed S, Kilkenny T, Alkaied H, Elsayegh D, et al. Cement pulmonary embolism after percutaneous vertebroplasty and kyphoplasty: an overview. Heart Lung. 2012;41(5):509–11.
Scroop R, Eskridge J, Britz GW. Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report. AJNR Am J Neuroradiol. 2002;23(5):868–70.
Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009;102(1):12–22.
Bach AG, Restrepo CS, Abbas J, Villanueva A, Lorenzo Dus MJ, Schopf R, et al. Imaging of nonthrombotic pulmonary embolism: biological materials, nonbiological materials, and foreign bodies. Eur J Radiol. 2013;82(3):e120–41.
Kim SY, Seo JB, Do KH, Lee JS, Song KS, Lim TH. Cardiac perforation caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJR Am J Roentgenol. 2005;185(5):1245–7.
Caynak B, Onan B, Sagbas E, Duran C, Akpinar B. Cardiac tamponade and pulmonary embolism as a complication of percutaneous vertebroplasty. Ann Thorac Surg. 2009;87(1):299–301.
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(1):210–3.
Baumann A, Tauss J, Baumann G, Tomka M, Hessinger M, Tiesenhausen K. Cement embolization into the vena cava and pulmonal arteries after vertebroplasty: interdisciplinary management. Eur J Vasc Endovasc Surg. 2006;31(5):558–61.
Heisel C, Norman T, Rupp R, Pritsch M, Ewerbeck V, Breusch SJ. In vitro performance of intramedullary cement restrictors in total hip arthroplasty. J Biomech. 2003;36(6):835–43.
Breusch SJ, Heisel C. Insertion of an expandable cement restrictor reduces intramedullary fat displacement. J Arthroplast. 2004;19(6):739–44.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Ramanathan, S., Vora, T., Gulia, A. et al. Pulmonary cement embolism in a child following total elbow replacement for primitive neuroectodermal tumour (PNET) of the humerus. Skeletal Radiol 46, 715–718 (2017). https://doi.org/10.1007/s00256-017-2602-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-017-2602-0