A piece of cement in your heart may not be the first thing that you think of when you suffer chest ... [+]
After a man went to the emergency room with chest pain, doctors eventually found a concrete piece of evidence of what was causing his symptoms. And that cemented the 56-year-old man’s appearance in a case report in the recent issue of the New England Journal of Medicine.
As you can imagine, making a case report in the New England Journal Medicine usually means something quite unusual has happened. In this case, unusual doesn’t mean something like “person wears denim formal wear, doesn’t realize that it’s 2021.” Instead, what Gabe Weininger and John A. Elefteriades, M.D., Ph.D. at the Yale University School of Medicine described in the case report was a very unusual medical event.
They told the tale of a man who had undergone a procedure to fix a compression fracture in one of his lumbar vertebrae. Having a compression fracture is not terribly unusual. The five lumbar vertebral bodies are the bones that are stacked on top of each other to form your lower spine. Your spine typically has to sustain a lot of force from supporting your body while you stand, walk, and do the whip, nae nae each day. A compression fracture occurs when a vertebral body collapses under the force. One way of fixing such a fracture is a kyphoplasty, which involves injected some polymethylmethacrylate medical cement to add back volume to the vertebral body.
Five days after the procedure, he suddenly began experiencing pain on the right side of his chest. This pain was worse when the man inhaled and radiated up to his right jaw and shoulder. After two days of such pain and shortness of breath, he went to the emergency room. A CT of the man’s chest revealed something unusual in his heart.
During emergency heart surgery, the surgeon found a sharp piece of cement about 10.1 cm in length and 0.2 cm in diameter in the right atrium of the man’s heart. This cement piece has actually pierced through the man’s right atrium and crossed from the heart into the man’s right lung, puncturing the lung. This was considered to be a cement embolism, because the piece had broken off from its origin in the man’s spine, entered his blood circulation through a vein, and traveled through the venous system to his heart. The surgeon removed the cement embolus and repaired the man’s right atrium.
After the surgery, it’s not as if doctors immediately kicked the man to the pavement. They observed him for a while and saw that he had hardly any post-operative complications. One month after the surgery, the man apparently had nearly completely recovered.
Again, this seems to have been unusual case. But was it a one-of-a-kind case? Well, a recent issue of the journal European Heart Journal - Case Reports had a case report entitled, “A spear to the heart—the accidental discovery of a giant cement embolism in the right heart: a case report.” In the case report, a team from the University of Essen in Germany (Moritz Lambers, Oliver Bruder, Heinrich Wieneke, Kai Nassenstein) described what happened after a 57-year-old had a kyphoplasty. The patient suffered shortness of breath on exertion and chest pain. As you can see in the following tweet, doctors found a “huge cement embolus” in the person’s right ventricle:
The case report indicated the incidence of cardiopulmonary cement embolism after such vertebral body procedures to be 0% to 23%. That’s quite a range. If you were told that there is a 0% to 23% chance of getting smacked in the face with a trash can lid, you’d probably step away from the lid. While these two case reports featured cases that were unusual for the size of the cement embolism, cement embolisms in general may not be that unusual. A systematic review of the literature published in 2009 published in the European Spine Journal indicated that “the risk of a pulmonary embolism ranges from 3.5 to 23%” after cement using procedures like balloon kyphoplasty and percutaneous vertebroplasty are used to fix osteoporotic fractures. The question is what can be done to reduce the likelihood of such embolisms and what alternative procedures could be used or developed. While not all of these embolisms may have significant health consequences, the idea of cement circulating in your blood may be a bit hard to take.
