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Severe hypercapnia due to pulmonary embolism of polymethylmethacrylate during vertebroplasty
Kay Stricker1, Rene Orler, Katrin Yen
1Departments 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.
Unlabelled:
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 CO(2). 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 (PaCO(2) 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.
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