Wireless Connection between Guide Wires and Bone Cement: Extravasated Methyl Methacrylate Mimicking a Retained Guide Wire

We present the case of a 56-year-old double lung transplant recipient with chest pain who underwent an attempted endovascular retrieval of what was described as a retained guide wire in the azygos vein. After successfully grasping the tip, the object further migrated to the right pulmonary artery complicating the retrieval. It was realized that the “wire” was extravasated methyl methacrylate from a recent percutaneous kyphoplasty. This is believed to be the first report of attempted endovascular retrieval of extravasated methyl methacrylate in the azygos system. We include the details of this case and briefly review the current literature on the management of extravasated methyl methacrylate from vertebral augmentation procedures. Extravasated methyl methacrylate in the venous system is a common finding after vertebral augmentation procedures and any radiopaque stripe arising from a cemented vertebral body should be first described as probable cement leakage. 1. Introduction Percutaneous vertebroplasty and kyphoplasty are increasingly utilized for rapid pain relief and increased mobilization in patients with vertebral body compression fractures. While major complications are rare, extravertebral leakage of methyl methacrylate has been reported to occur in up to 73% of vertebral augmentation procedures with venous leaks occurring in up to 24% of cases [1]. The vast majority of patients with cement leakage and even cement pulmonary embolism remain asymptomatic. Occasionally in symptomatic patients, embolized intravascular cement has been retrieved using endovascular snares. Endovascular foreign body retrieval is not only a beneficial procedure for patients, but also for physicians as most retained objects are iatrogenic in origin [2]. We describe a patient who presented to the emergency department with chest pain and what was believed to be a retained guide wire in the azygos vein found on chest imaging. Attempted snare retrieval was performed, and after further migration, the foreign body was discovered to be extravasated methyl methacrylate from prior vertebral body augmentation. 2. Case Report A 56-year-old male with history of double lung transplantation for emphysema presented to the emergency department with chest pain. Initial PA and lateral chest radiographs showed a curvilinear density in the azygos vein (Figure 1(a)) which was thought to be a retained guide wire, likely from one of multiple previous PICC placements. A chest CT confirmed the “wire” within the azygos vein beginning at the T12 level and extending superiorly with the distal tip