This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (22) Citing Articles via Google Scholar Google Scholar Articles by Stricker, K. Articles by Luginbühl, M. Search for Related Content PubMed PubMed Citation Articles by Stricker, K. Articles by Luginbühl, M. Related Collections Cardiovascular Surgery Complications Monitoring (Cardiac) Monitoring (Non-cardiac)

---

GENERAL ARTICLES

Severe Hypercapnia Due to Pulmonary Embolism of Polymethylmethacrylate During Vertebroplasty

Kay Stricker, MD^*, Rene Orler, MD, Katrin Yen, MD, Jukka Takala, MD, PhD, and Martin Luginbühl, MD^*

Departments of *Anesthesiology and Orthopedic Surgery, University Hospital of Bern, Switzerland; and Institute for Legal Medicine and Department of Intensive Care Medicine, University of Bern, Switzerland

Address correspondence to Kay Stricker, MD, DEAA, Department of Anesthesiology, University Hospital, CH-3010 Bern, Switzerland. Address e-mail to Kay.Stricker{at}insel.ch Reprints will not be available from the authors.

Pulmonary polymethylmethacrylate embolism is a rare but potentially fatal complication of percutaneous vertebroplasty. Clinical signs are typical for pulmonary embolism: they include respiratory distress, hypotension, and decreases in end-tidal CO₂. We report a case of fatal pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty that initially presented with hypertension (arterial blood pressure 190/90 mm Hg), normocardia, and hypercapnia (PaCO₂ 96 mm Hg), along with loss of consciousness. Several pieces of polymethylmethacrylate were found in the pulmonary vasculature at autopsy.

IMPLICATIONS: Osteoporotic spine fractures are increasingly treated by injection of bone cement into the vertebral body. Polymethylmethacrylate embolism is a rare but potentially fatal complication. We report on a case of polymethylmethacrylate embolism that was at first unrecognized because of uncharacteristic signs and symptoms.

This article has been cited by other articles:

				Y. J. Kim, J. W. Lee, K. W. Park, J.-S. Yeom, H. S. Jeong, J. M. Park, and H. S. Kang Pulmonary Cement Embolism after Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fractures: Incidence, Characteristics, and Risk Factors Radiology, April 1, 2009; 251(1): 250 - 259. [Abstract] [Full Text] [PDF]

				A. Venmans, P.N.M. Lohle, W.J. van Rooij, H.J.J. Verhaar, and W.P.Th.M. Mali Frequency and Outcome of Pulmonary Polymethylmethacrylate Embolism during Percutaneous Vertebroplasty AJNR Am. J. Neuroradiol., November 1, 2008; 29(10): 1983 - 1985. [Abstract] [Full Text] [PDF]

				J. Krebs, S. J. Ferguson, S. P. Hoerstrup, B. G. Goss, A. Haeberli, and N. Aebli Influence of Bone Marrow Fat Embolism on Coagulation Activation in an Ovine Model of Vertebroplasty J. Bone Joint Surg. Am., February 1, 2008; 90(2): 349 - 356. [Abstract] [Full Text] [PDF]

				J. Krebs, N. Aebli, B.G. Goss, K. Wilson, R. Williams, and S.J. Ferguson Cardiovascular Changes after Pulmonary Cement Embolism: An Experimental Study in Sheep AJNR Am. J. Neuroradiol., June 1, 2007; 28(6): 1046 - 1050. [Abstract] [Full Text] [PDF]

				K. J. Lim, S. Z. Yoon, Y.-S. Jeon, J. H. Bahk, C. S. Kim, J.-H. Lee, and J. W. Ha An Intraatrial Thrombus and Pulmonary Thromboembolism as a Late Complication of Percutaneous Vertebroplasty Anesth. Analg., April 1, 2007; 104(4): 924 - 926. [Abstract] [Full Text] [PDF]

				A. Uemura, Y. Numaguchi, M. Matsusako, N. Kobayashi, Y. Saida, and M. Rahman Effect on Partial Pressure of Oxygen in Arterial Blood in Percutaneous Vertebroplasty AJNR Am. J. Neuroradiol., March 1, 2007; 28(3): 567 - 569. [Abstract] [Full Text] [PDF]

				A. G. Hadjipavlou, M. N. Tzermiadianos, P. G. Katonis, and M. Szpalski Percutaneous vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures and osteolytic tumours J Bone Joint Surg Br, December 1, 2005; 87-B(12): 1595 - 1604. [Full Text] [PDF]