Acute Respiratory Distress Syndrome Associated With Pulmonary Cement Embolism Following Percutaneous Vertebroplasty With Polymethylmethacrylate

In Brief Study Design. A case of acute respiratory distress syndrome following percutaneous vertebroplasty is described. Objective. To alert clinicians to the potential occurrence of acute respiratory distress syndrome following use of polymethylmethacrylate bone cement. Summary of Background Data. Noncardiogenic pulmonary edema has not been reported following intravertebral injection of polymethylmethacrylate. Methods. A 68-year-old woman underwent percutaneous vertebroplasty for a painful L5 compression fracture under local anesthesia. A contralateral transpedicular approach was made to inject polymethylmethacrylate. Results. On the third postoperative day, she developed arthralgia, myalgia, fever, and frequent coughing. Chest radiography revealed bilateral, multifocal, patchy consolidations, suggestive of acute respiratory distress syndrome, and a 5-cm-long tubular radiopacity in the right pulmonary artery. She died 20 days after the vertebroplasty. Conclusion. This case illustrates that clinicians must be aware of the potential occurrence of acute respiratory distress syndrome in patients who received percutaneous vertebroplasty. Among the cardiovascular and respiratory complications associated with the use of polymethylmethacrylate cement in arthroplasty, a noncardiogenic pulmonary edema has not been documented. We report on 1 patient with progressive hypoxemia and diffuse pulmonary infiltrates following intravertebral injection of polymethylmethacrylate. Chest radiograph and computed tomography confirmed the presence of the cement in the pulmonary artery. The patient was treated with anticoagulants, inhaled nitric oxide, diuretics, antibiotics, and eventually pulmonary embolectomy. She died 20 days after the vertebroplasty.