Incidental Right Atrial Appendage Cement Embolus Detected Years After Percutaneous Vertebroplasty and Excised During Coronary Artery Bypass Grafting: A Case Report
| Author | Mohhamad Ali Yousefnia | en |
| Author | Naser Jalilifar | en |
| Author | Neda Behzad | en |
| Author | Pourya Kanani | en |
| Orcid | Mohhamad Ali Yousefnia [0009-0008-2486-0474] | en |
| Orcid | Naser Jalilifar [0009-0002-7756-2936] | en |
| Orcid | Neda Behzad [0000-0001-8963-4285] | en |
| Orcid | Pourya Kanani [0009-0005-6343-7052] | en |
| Issued Date | 2026-12-31 | en |
| Abstract | Introduction: Intracardiac cement embolism is an uncommon complication of vertebral augmentation that occurs when polymethyl methacrylate leaks into the perivertebral veins and migrates to the right heart. Most cases present within 48 hours of the procedure and are accompanied by pulmonary cement emboli. Detection several years after surgery is uncommon, and the embolus may be mistaken for a cardiac tumor or a calcified thrombus. Case Presentation: A 72-year-old woman presented to an outpatient clinic with an episode of typical chest pain. She had undergone cement vertebroplasty for osteoporotic compression fractures 4 and 2 years earlier, followed by spinal fixation. Transthoracic echocardiography, performed before coronary angiography, showed a highly echo-dense, bone-like mass measuring 17 × 12 mm attached to the right atrial free wall. The ejection fraction was normal, and the estimated pulmonary artery pressure was 35 mm Hg. Transesophageal echocardiography localized the mass to the right atrial appendage, with no attachment to the valves or interatrial septum. Coronary angiography showed 3-vessel disease with very severe left anterior descending artery stenosis. On the same day, fluoroscopy showed a plate-like, semimobile, bone-like density that moved with the heart and was unrelated to the coronary arteries. Chest radiography and noncontrast computed tomography (CT) showed a bone-like density along the right atrial contour, with no evidence of cement in the pulmonary arteries. The patient subsequently underwent coronary artery bypass grafting with 4 grafts on cardiopulmonary bypass with bicaval cannulation. The mass was completely excised together with part of the appendage tissue. Histopathological examination confirmed a firm cement fragment measuring 40 × 15 × 2 mm with scant fibrinoid material. The operation was uneventful, and postoperative echocardiography showed no residual mass. Conclusions: An intracardiac cement embolus may remain clinically silent for years and be detected incidentally. Bone-like density on echocardiography, fluoroscopy, radiography, and CT, together with a history of vertebral augmentation, supports the diagnosis. Echocardiography underestimated the fragment length by more than half; therefore, procedural planning should incorporate multiple imaging modalities. | en |
| DOI | https://doi.org/10.69107/mca-175414 | en |
| URI | https://brieflands.com/journals/mca/articles/175414 | en |
| Keyword | Percutaneous Vertebroplasty | en |
| Keyword | Bone Cement | en |
| Keyword | Coronary Artery Bypass Grafting | en |
| Keyword | Foreign Body | en |
| Publisher | Brieflands | en |
| Title | Incidental Right Atrial Appendage Cement Embolus Detected Years After Percutaneous Vertebroplasty and Excised During Coronary Artery Bypass Grafting: A Case Report | en |
| Type | Case Report | en |