Right Ventricular Perforation After Vertebroplasty.

CASE SUMMARY: A 75-year-old woman presented with cardiac tamponade 6 months after percutaneous vertebroplasty following an otherwise asymptomatic course. Transthoracic echocardiography revealed pericardial effusion and a hyperechoic linear structure penetrating the right ventricular free wall. Comparison of radiographs demonstrated interval migration of bone cement into the cardiac silhouette, and computed tomography clearly demonstrated right ventricular free wall perforation. Surgical findings confirmed the diagnosis. Although intracardiac cement embolism has been reported, delayed presentation after an asymptomatic course is rare.

TAKE-HOME MESSAGES: Delayed, clinically silent bone cement migration can present as life-threatening cardiac tamponade. Serial radiography, echocardiography, and computed tomography are critical for recognizing delayed intracardiac cement migration and guiding urgent surgical management.