CTICasesVertebroplasty Methyl Methacrylate Cement Embolism to the Azygos Vein
Imaging findings
Chest radiograph demonstrates a highly radiopaque, linear, dense structure projecting over the expected location of the azygos vein arch. Intra-procedural fluoroscopy from a prior vertebroplasty confirms the extravasation of methyl methacrylate bone cement into the vertebral venous plexus with subsequent embolization and casting of the azygos vein.
Key takeaways
Extravasation of methyl methacrylate cement into the vertebral venous plexus is a well-known risk of vertebroplasty and kyphoplasty. The embolized cement can travel to the azygos vein or pulmonary vasculature, where it rapidly solidifies, presenting radiographically as a dense, linear, foreign structure that can be easily mistaken for an indwelling catheter or dense vascular calcification.
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