In the emergency room, doctors see chest pain every day. But this 56-year-old patient, who came complaining of chest discomfort and difficulty breathing for two days, hid a surprise that no one expected. A week after a seemingly ordinary back operation, emergency imaging tests revealed a long and very dense foreign body in the heart: a cement stick.
A chest pain that hid cement in the heart
The man arrived at the hospital with so-called pleuritic chest pain, which worsened on inspiration, and unusual shortness of breath. The chest x-ray already intrigues emergency doctors, but the scanner confirms the unthinkable: a rigid structure inside the heart itself, in the right chambers. It does not look like a clot or the usual pacemaker or probe material.
During cardiac surgery, doctors discovered a sharp fragment of orthopedic cement, approximately 10 centimeters long, which had perforated the right atrium and then the right lung. A week earlier, this patient had undergone kyphoplasty (or kyphoplasty) to treat a vertebral compression fracture. The cement injected into the vertebra leaked into the venous network, solidified and migrated to the heart. The fragment was removed, the heart tear repaired, and a month later the symptoms had almost disappeared. However, the story could have turned into a tragedy.
How can a cement embolism occur?
To relieve painful vertebral compression, linked for example to osteoporosis, interventional radiology and spine surgery teams regularly use vertebroplasty or kyphoplasty. In these techniques, an acrylic cement based on polymethylmethacrylate is injected into the heart of the weakened vertebra in order to stabilize it. In a previous article, Laurent Grange, rheumatologist at Grenoble Alpes University Hospital, described kyphoplasty: “This method consists of inject acrylic cement into a vertebra of the spine which is very
packed (broken)“.
During injection, a small amount of cement may escape through the vertebral veins and enter the central venous circulation. Clinical studies report extravasation of cement into the main veins in approximately 23% of operated patients, but the vast majority of these leaks remain silent. In a minority of cases, the solidified cement forms a real “stick” which travels towards the right heart or the pulmonary arteries: this is cement embolism.
A rare complication, but one to watch out for
In most cases, cement fragments that reach the pulmonary circulation cause no signs and go unnoticed. When symptoms appear, they resemble those of a classic pulmonary embolism: sudden chest pain, shortness of breath, sometimes discomfort, palpitations or drop in blood pressure. The chest CT scan is the key test to make the diagnosis, because the cement is seen as a very dense material in the heart or pulmonary arteries. Some teams have attempted endovascular extractions (in the blood vessels), using forceps and catheters, but cardiac surgery remains the preferred recourse in the event of perforation or significant bleeding.
So many very different situations, but which remind us that after an intervention with cement injection into the spine, any unusual chest pain or difficulty breathing justifies urgent evaluation, even if these complications remain exceptional given the number of vertebroplasties performed each year.