Question:

Which of the following will have an appearance most similar to a PMMA embolism on a CT scan of the chest?
1. Aspiration of glass.
2. Broncholithiasis.
3. Granulomatous disease.
4. IV injection of mercury.
5. Aspiration of plastic.





Answer:

The correct answer for the question "Which of the following will have an appearance most similar to a PMMA embolism on a CT scan of the chest?" is:

4. IV injection of mercury.



Explanation
1. Aspiration of glass will produce a hyperdense lesion located in the bronchial distribution.  Although it is hyperdense, the location of the lesion is the key distinguishing feature.  [Aspiration of a foreign body (glass, metal or plastic) will result in a hyperdense lesion located within the bronchial distribution (differential table)].

2. Broncholithiasis may have a similar appearance to cement embolization on conventional radiography, but not usually on CT.  Broncholiths will be found in the bronchi rather than the pulmonary arteries.  The key is to identify the lesion in the bronchi.  Another clue that the patient may have a broncholith is that there are signs of obstruction, which are usually not seen with cement embolization.  [A broncholith is usually a solitary lesion which narrows or completely occludes the bronchial lumen (summary table)].

3. Granulomatous disease can have a varied appearance depending on the cause (histoplasmosis, silicosis, tuberculosis).  Granulomatous disease is localized to the lung parenchyma, but is usually not found isolated to the arterial distribution.  If the arterial distribution is involved, other parts of the lung parenchyma are typically involved.  Furthermore, granulomas typically will enhance with contrast administration, whereas a cement embolism will not enhance.  [These lesions are located within the lung parenchyma and typically enhance with contrast administration (summary table)].

4. IV administration of hyperdense material such as iodine-base contrast and mercury will result in a hyperdense lesion with a branching or globular pattern, which may mimic cement pulmonary embolization if the proper history regarding the patient or the type of study was not available.  [Injection of hyperdense material has a branching or globular hyperdense material in the pulmonary arterial distribution, best seen in bone windows on non-contrast chest CT (summary table)].

5. Aspiration of plastic will produce a hyperdense lesion located in the bronchial distribution.  Much like the example with glass listed earlier, the location of the lesion is the key distinguishing feature.  [Aspiration of a foreign body (glass, metal or plastic) will result in a hyperdense lesion located within the bronchial distribution (differential table)].



From the manuscript:
Investigation of polymethylmethacrylate pulmonary embolus in a patient ten years following vertebroplasty
Radiology Case. 2011 Oct; 5(10):14-21


This article belongs to the Interventional section.




Bookmark and Share

From the manuscript

Investigation of polymethylmethacrylate pulmonary embolus in a patient ten years following vertebroplasty

Free full text article: Investigation of polymethylmethacrylate pulmonary embolus in a patient ten years following vertebroplasty

Abstract
Percutaneous vertebroplasty (PV) is a procedure commonly used for the treatment of vertebral compression fractures, and the number of procedures has been steadily increasing over the past decade. We report a case of an 81 year old female with a history of breast cancer that developed two vertebral body compression fractures and was subsequently treated with PV. The patient developed a subsegmental pulmonary polymethylmethacrylate (PMMA) embolus as a complication of the procedure. Ten years following the procedure, she remained asymptomatic with the PMMA embolus being discovered incidentally during workup for a suspected chronic obstructive pulmonary disease (COPD) exacerbation. In reviewing the case, we describe the typical presentation of a pulmonary PMMA embolus and consider methods to decrease the incidence of this complication.






References



1. Gangi A, Kastler BA, Dietemann JL. Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy. ANJR American Journal of Radiology 1994; 15:83-86
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


2. Deramond H, Depriester C, Galibert P, Le Gars D. Percutaneous vertebroplasty with polymethylmethacrylate: Technique, indications, and results. Radiology Clinics of North America 1998; 36:533-46
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


3. Young C, Munk PL, Heran MK. Treatment of severe vertebral body compression fractures with percutaneous vertebroplasty. Skeletal Radiology 2011 Mar 27
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


4. Abdul-Jalil Y, Bartels Joerg, Alberti O. Delayed presentation of pulmonary polymethylmethacrylate emboli after percutaneous vertebroplasty. Spine 2007; 32:589-593
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


5. Gangi A, Guth S, Imbert JP, Marin H, Dietemann JL. Percutaneous vertebroplasty: indications, technique, and results. Radiographics 2003; 23(2):e10
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


6. Lee MJ, Dumonski M, Cahill P. Percutaneous treatment of vertebral compression fractures: a meta-analysis of complications. Spine 2009; 34:1228-1232
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


7. Venmans A, Lohle PNM, Van Rooij WJ. Frequency and outcome of pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty. American Journal of Neuroradiology 2008; 29:1983-1985
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


8. Langley RJ, Mishra NC, Peņa-Philippides JC, Hutt JA, Sopori ML. Granuloma formation induced by low-dose chronic silica inhalation is associated with an anti-apoptotic response in Lewis rats. Journal of Toxicology and Environmental Health Part A 2010; 73(10):669-83
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


9. Venmans A, Klazen CAH, Lohle PNM. Percutaneous vertebroplasty and pulmonary cement embolism: results from VERTOS II. American Journal of Neuroradiology 2010; 31:1451-1453
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


10. Thomson LA, Law FC, James KH, Matthew CA, Rushton N. Biocompatibility of particulate polymethylmethacrylate bone cements: a comparative study in vitro and in vivo. Biomaterials 1992; 13(12):811-8
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


11. Robinson Y, Heyde CE, Forsth P, Olerud C. Kyphoplasty in osteoporotic vertebral compression fractures: Guidelines and technical considerations. Journal of Orthopaedic Surgery and Research 2011; 6(1):43
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine




Search for articles with similar topics:

Keyword search:

1. Pulmonary cement embolus

2. polymethylmethacrylate

3. vertebroplasty

4. kyphoplasty


This article belongs to the Interventional section.


Search for more in the Internet

Peer-reviewed Radiology Search




Discuss it!

Bookmark and Share




© Journal of Radiology Case Reports - The Interactive Radiology Journal
Affiliated journal of Radiolopolis - The International Radiology Community


The Journal of Radiology Case Reports