title: Fat embolism syndrome following percutaneous vertebroplasty: a case report.
abstract: BACKGROUND
  Vertebroplasty is commonly performed for management of pain associated with vertebral compression fractures. There have been two previous reports of fatal fat embolism following vertebroplasty. Here we describe a case of fat embolism syndrome following this procedure, and also provide fluoroscopic video evidence consistent with this occurrence.
  
  
  OBJECTIVE
  The purpose of this study was to review the literature and report a case of fat embolism syndrome in a patient who underwent percutaneous vertebroplasty for compression fracture.
  
  
  METHODS
  The study design for this manuscript was of a clinical case report.
  
  
  METHODS
  A 68-year-old woman who developed sudden back pain with minimal trauma was found to have a T6 vertebral compression fracture on radiographs and bone scans. Percutaneous vertebroplasty of T5 and T6 was performed.
  
  
  RESULTS
  Fluoroscopic imaging during the procedure demonstrated compression and rarefaction of the fractured vertebra associated with changes in intrathoracic pressure. Immediately after the procedure, the patient's back pain resolved and she was discharged home. Two days later, she developed increasing respiratory distress, confusion, and chest pain. A petechial rash on her upper arms also appeared. No evidence of bone cement leakage or pulmonary filling defects were seen on computed tomography-pulmonary angiography. Brain magnetic resonance imaging demonstrated hyperintensities in the periventricular and subcortical white matter on T2/fluid-attenuated inversion recovery sequences. A diagnosis of fat embolism syndrome was made, and the patient recovered with conservative management.
  
  
  CONCLUSIONS
  Percutaneous vertebroplasty is a relatively safe and simple procedure, reducing pain and improving functional limitations in patients with vertebral fractures. This case demonstrates an uncommon yet serious complication of fat embolism syndrome. Clinicians must be aware of this complication when explaining the procedure to patients and provide prompt supportive care when it does occur.
authors: Faculty of Medicine, University of New South Wales, Level 2, ASGM Building/Botany St, Sydney, New South Wales 2052, Australia; Department of Respiratory Medicine, St. George Hospital, Gray St, Kogarah, New South Wales 2217, Australia. Electronic address: h.ahmadzai@unsw.edu.au.
authors: Hasib
authors: H
authors: Ahmadzai
authors: Faculty of Medicine, University of New South Wales, Level 2, ASGM Building/Botany St, Sydney, New South Wales 2052, Australia; Department of Respiratory Medicine, St. George Hospital, Gray St, Kogarah, New South Wales 2217, Australia.
authors: Scott
authors: S
authors: Campbell
authors: Faculty of Medicine, University of New South Wales, Level 2, ASGM Building/Botany St, Sydney, New South Wales 2052, Australia; Department of Respiratory Medicine, St. George Hospital, Gray St, Kogarah, New South Wales 2217, Australia.
authors: Constantine
authors: C
authors: Archis
authors: Department of Radiology, St. George Private Hospital, 1 South St, Department of Radiology, Kogarah, New South Wales 2217, Australia.
authors: William A
authors: WA
authors: Clark
mesh_terms: D000368:Aged; D004620:Embolism, Fat / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005471:Fluoroscopy; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications; D016103:Spinal Fractures / Q000601:surgery*; D054854:Vertebroplasty / Q000009:adverse effects* / Q000379:methods
keywords: Fat embolism; Percutaneous vertebroplasty; Polymethylmethacrylate; Vertebral fracture