A 57-year-old double lung transplant patient nearly died after cement used to fix a fracture in his spine leaked into the arteries of new organs.
The man, who is unidentified in a case report from Houston Methodist Hospital in Texas, was given a two transplanted lungs.
Subsequently, he had a fairly common back pain procedure, in which cement is injected between vertebrae to help alleviate pain and stress from the back.
But according to the case report, the cement used in the procedure ultimately leaked into his blood vessels and making its way into the arteries of the man’s new lungs.
A scan of the man’s lungs showed ‘dense opacities,’ evident in white streaks (at points of arrows), that nearly cut off the blood flow to his new lungs
Lung transplants are relatively rare. About 2,000 people receive a lung transplant each year in the US, which is just over one tenth of the number of kidney transplants done every year.
This man was one of those 2,000, but, according to the case report, the first to ever have the back procedure after such a transplant.
Sometime after surgeons successfully transplanted donor lungs to the man, he developed back pain that was not responding well to pain medication.
Ostensibly, the man had a back fracture, osteoporosis or spinal trauma, which was repaired through a relatively new procedure called a percutaneous vertebral augmentation.
The augmentation uses an injection of medical-grade cement to fill a fracture in a vertebra.
Filling the crack alleviates pain in the back by stabilizing the weakened vertebra and has a become fairly common solution to difficult-to-treat fractures.
A 2011 study of the procedure treated cement leakages as being of little concern, although not a particularly uncommon one.
The report said that leakages occurred in between six and 52 percent of cases, but that it was ‘usually of no clinical significance,’ except for occasionally causing some nerve pain.
The same review called the movement of cement into the spaces of the spine containing blood vessels or nerves are rare complications, most cases of which are ‘clinically silent,’ but apparent in a CT scan.
In its very next line, however, the report says that the this may happen in as many as 40 percent of cases.
A different medical cement that had not been approved by the Food and Drug Administration, but was nonetheless used in similar procedures, has been accused of killing at least four spine patients after it leaked into their bloodstreams and clotted there.
The man from the recent case study was much more fortunate.
Just one day after his cement injection, the man returned to the hospital, complaining of shortness of breath.
He told his doctors that he hadn’t been wheezing or coughing, but their exam revealed that his heart was beating too fast and out of its normal rhythm, a condition called sinus tachycardia.
Otherwise, he seemed okay: his lungs were functioning at 90 percent, and all of his other vital signs were in the normal range.
But further scans showed ‘thin dense opacities’ in his blood vessels, reaching into his lungs.
The cement had leaked into his blood system and was causing an embolism, or blockage, in the main artery that delivers blood to the lungs.
If blood flow becomes completely cut off from the lungs, shutting them down and causing sudden death.
In most instances, these blockages are blood clots, and may dissolve on their own.
But the cement was unlikely to go anywhere, and blood was clotting up around it.
The man’s doctors gave him a dose of enoxaparin, a drug that stops blood clotting.
He was discharged from the hospital with a three-month prescription of the drug.
Upon his return to the hospital three months later, the man still had the cement, but his blood pressure, breathing and all other vital signs were still fine.
Remarkably, the same was true six months after the blockage began, and even a year later, when a scan revealed ‘stable thin dense opacities without any progression of cement embolism.’
In other words, it appears the man will live out the rest of his life with secondhand lungs and cement in both his back and his blood.