Asymptomatic Bone Cement Pulmonary Embolism after Vertebroplasty: Case Report and Literature Review

Abstract

Introduction. Acrylic cement pulmonary embolism is a potentially serious complication following vertebroplasty. Case Report. A 70-year-old male patient was treated with percutaneous vertebroplasty for osteoporotic nontraumatic vertebral collapse of L5-S1. Asymptomatic pulmonary cement embolism was detected on routine postoperative chest radiogram and the patient was treated with enoxaparin, amoxicillin, and dexamethasone. At the followup CT scan no further migration of any cement material was reported; and the course was uneventful. Discussion. The frequency of local leakage of bone cement is relatively high (about 80–90%), moreover, the rate of cement leakage into the perivertebral veins (seen in up to 24% of vertebral bodies treated) with consequent pulmonary cement embolism varies from 4.6 to 6.8% (up to 26% in radiologic studies); the risk of embolism is increased with the liquid consistency of the cement and with the treatment of some malignant lesions. Patients may remain asymptomatic and develop no known long-term sequelae. Conclusions. Our ancedotal case illustrates the need for close monitoring of patients undergoing percutaneous vertebroplasty and emphasizes the importance of prompt and correct diagnosis and treatment, even if actually there is no agreement regarding the therapeutic strategy.

Glue masquerading as a catheter: Retrieval of embolized vertebroplasty cement

“…Gross specimen of bone cement Due to variable incidence of pulmonary embolism, some studies have recommended routine radiographs within 24 hours of procedure for screening. [4,6,7] Various approaches in the treatment of bone cement embolism have been described, depending on the location of the cement and the severity of symptoms. Options include conservative management with or without anticoagulation, endovascular retrieval, and open-heart surgery.…”

Pulmonary Artery Cement Embolism after a Vertebroplasty

“…In this case report, we presented an incidental finding of a cement embolism in the pulmonary trunk and both pulmonary arteries following vertebroplasty to emphasize the importance of close monitoring of patients following this procedure. Around 100 cases of cement embolism following vertebroplasty were reported in the literature with the majority being asymptomatic [ 6 ]. Previous studies reported cement extrusion into the venous system during the procedure as the primary cause of cement embolisms [ 7 ].…”

“…While there are no clear guidelines to screen for asymptomatic pulmonary embolisms, some authors recommend routine chest radiographs following vertebroplasty or kyphoplasty in asymptomatic patients [ 8 , 19 ]. A high-density opacity in a tubular branching pattern, corresponding to pulmonary arterial distribution, is usually suggestive of cement pulmonary embolism [ 6 ].…”

“…Some authors recommended no treatment but monitoring those patients as long as they remain asymptomatic and there are no interval changes clinically or radiographically [ 9 ], while other authors recommended that, whether symptomatic or not, they should be treated with anticoagulation therapy for 6 months [ 19 ]. Surgical or percutaneous embolectomy was suggested by few authors in case of massive central embolism [ 6 , 20 ].…”

Pulmonary cement embolism following balloon�kyphoplasty: The impact of a procedural complication in a�new era for lung cancer management

“…Its exact prevalence is unknown, ranging between 2 and 26% according to the selected diagnostic imaging method (4). Considering the frequent paucity of symptoms and the use of protocols that do not include thoracic imaging tests following the procedure, it is believed that these estimates may be undervalued (5,6). The diagnosis usually implies a high clinical suspicion, and in patients with lung cancer, with the multiplicity of respiratory symptoms and the frequent overlap with other lung chronic diseases, it may be even more challenging.…”