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• W4387248971 abstract "SESSION TITLE: Imaging Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Percutaneous vertebroplasty (PVP) is a minimally invasive procedure performed commonly for compression fractures and osteolytic vertebral lesions (1). A very rare, late complication of the same is leakage of the cement into the surrounding vasculature, followed by embolization to other areas. We present a case of leakage of vertebral augmentation cement and it's subsequent presentation as tricuspid valve chordae calcification. CASE PRESENTATION: 71 year old male with a past medical history of abdominal aortic aneurysm, hypertension, CKD 3a, emphysema, hyperlipidemia, vertebral compression fracture, nicotine dependence, PVD. He resented to his cardiologist's office for follow up after a fall.He reports that he fell impacting his left elbow, was unsure if he lost consciousness. He denies any lightheadedness or dizziness, chest pain, shortness of breath or palpitations. ER workup revealed an unremarkable physical exam and lab work. He was recommended a Zio monitor and for 3 days, and an echo was ordered. Zio monitor showed 32 episodes of SVT, longest lasting 21 minutes with an average rate of 111 bpm. Echo showed a preserved ejection fraction but was significant for thickened and diffusely calcified tricuspid valve chordae. A follow up MRI showed a thin, curved structure, 3 mm in thickness and 31 mm in linear extent in the right ventricular cavity, attached to the inferoseptum. Interestingly, the MRI also revealed that the RV structure has the same morphology as a small amount of augmentation cement that is extruded in small paralumbar veins. There is a likewise a tiny amount of embolized cement in a few left sided subsegmental pulmonary arteries. Further investigation into the patient's history revealed that he underwent vertebral cement augmentation in 2017. Comparison with previous images showed that the findings have been consistent in a CT in 2018 and then again on his echo in 2020. It was deemed that these findings are of doubtful clinical significance given the long term stability. Patient was recommended to undergo follow up echo after one year. DISCUSSION: PVP is a minimally invasive procedure that involved the use of polymethylmethacrylate injection into the targeted vertebral body. This organizes very quickly, thereby providing stability to the vertebral bone and minimizing the need for spinal surgery (2). Complications include pain at the injection site, bleeding and rarely, risk of embolization of the cement into the vasculature, leading to complications. Several case of PE have been previously reported. Our case presents a rare exampled where in the cement deposited on the tricuspid chordae, and was picked up as an incidental finding on an echo for syncope workup. What is remarkable to note is that it did not interfere with the valvular function and no further intervention was required, however it can be detrimental and lead to complications like heart failure, atrial fibrillation and tricuspid insufficiency. CONCLUSIONS: Cardiac involvement post PVP cement leakage is a rare complication. It is important to keep in mind this differential in a patient who presented with intracardiac foreign body and has a undergone PVP. Multimodal imaging modalities are essential for identifying the same. REFERENCE #1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604617/ REFERENCE #2: https://pubmed.ncbi.nlm.nih.gov/9403451/ DISCLOSURES: No relevant relationships by Tapan Buch No relevant relationships by Lavleen Kaur No relevant relationships by Khyati Khattar" @default.
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• W4387248971 date "2023-10-01" @default.
• W4387248971 modified "2023-10-03" @default.
• W4387248971 title "CEMENT...IN THE HEART?" @default.
• W4387248971 doi "https://doi.org/10.1016/j.chest.2023.07.2677" @default.
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