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.