CS KIM1, S KIM1, E BAE1
1Chonnam National University Medical School, Gwnagju, South Korea
Background: Percutaneous vertebroplasty (PVP) remains widely used to treat osteoporotic vertebral fractures. Although minor cement leakage is the most frequently reported complication of PVP, the cement can leak into the vena cava and pulmonary arteries, causing pulmonary embolism. However, cement leakage that misapprehended to be a remnant guidewire in the inferior vena cava (IVC) has not previous been described.
Case report: A 73-year-old woman with a history of lumbar fracture presented with vomiting, diarrhea, and acute kidney injury. Physical examination revealed ascites and anuria. Serum creatinine level was 6.4 mg/dL. She was admitted to the intensive care unit, and a catheter was inserted into the right femoral vein for emergency hemodialysis. Follow-up abdominal radiography showed a long, radio-opaque, guidewire-like material along the IVC. However, the procedure of catheter insertion was performed without errors or complications. Several years ago, she underwent PVP for vertebral compression fractures sustained in a fall. Abdominal computed tomography scan showed a long cement leakage in the IVC, which did not clog the arterial segments for branches.
Conclusions: Our case indicates that a high degree of suspicion is required for discriminating the cement leakage in the IVC in patients after PVP, because it can mimic a remnant guidewire or can interrupt the advancement of a guidewire during emergency femoral catheter insertion. Retrieval is necessary when large cement fragments in the venous system increase risk during embolization. If the fragment is too large for extraction through the IVC, it should be retrieved through a surgical approach. In our case, because the patient was old and had no symptom of embolization, retrieval of the fragments from the IVC was not performed.
Assistant Professor, Division of Nephrology, Department of Internal Medicine.
Chonnam National University Medical School.