DISCUSSION
In this case, the patient suffered a sudden loss of consciousness about
14 hours after PVP. Emergency bedside echocardiography showed U-shaped
strong echoes in the right heart and pericardial effusion in the apex of
the heart. Combined with the operation history and CT, it was considered
that the leaking cement entered the lumbar segment vein through the
paravertebral plexus, and entered the superior vena cava and the right
atrium through the odd vein. Eventually, it entered the superior vena
cava and the right atrium through the odd vein, and the bone cement
gradually hardened and bended as it traveled with the blood flow, so
that the tip pierced the heart and caused perforation of the heart. This
is the first reported case of a patient who suffered a sudden loss of
consciousness after PVP within one day, and the doctor made the
diagnosis of ICE in a very short time.
Previous studies have found that most patients with ICE have dyspnea or
chest pain as the first symptoms after PVP, 5-8 the
duration of onset is inconsistent, and rare cases may be
asymptomatic.6 But no matter what the clinical
symptoms are, the most urgent need is for early detection and immediate
treatment. X-ray has special advantages for the discovery of metallic
foreign bodies, but it can usually not determine the specific location
of the mass in the heart cavity, and some chest X-rays only show
thickening of lung texture.8 Chest CT can confirm the
location of cement emboli in the heart, and at the same time can judge
whether there is pulmonary embolism, 5,7-8 but it
takes a long time for the examination and the results to be obtained,
and it is impossible to observe the immediate changes of the foreign
body.
The heart is a motor organ, the attention should be paid to the
migratory nature of foreign bodies during diagnosis. Echocardiography
has almost 100 % sensitivity for assessing the size, position and
mobility of foreign bodies in the heart.9 Bedside
echocardiography is non-invasive and simple, especially for detecting
non-metallic foreign bodies. It can identify valve damage, intracardiac
shunt and detect myocardial tears caused by intracardiac foreign bodies.
Because of similar clinical symptoms, ICE is most likely to be
misdiagnosed as coronary atherosclerotic heart disease, and the computed
tomography angiography sometimes show negative
results,5 the bedside echocardiography is also helpful
in distinguishing that primary heart diseases.
This case reminds that when encountering patients with a sudden loss of
consciousness or other atypical symptoms after PVP, it is necessary to
perform echocardiography as soon as possible to assess the heart
condition, which is consistent with the view of Yu
Song.8 Special attention should be paid to the
possibility of ICE, especially echocardiography shows a strong echo of a
foreign body in the heart accompanied by pericardial effusion in
patients after PVP.