Pulmonary cement embolism after percutaneous vertebroplasty. (RCD code: II‑1C.0)

Pulmonary cement embolism is a relatively new medical issue. The cement used in orthopedics is not even mentioned in the 2014 European Society of Cardiology (ESC) guidelines on the diagnosis and management of acute pulmonary embolism, however it will be a more frequent occurrence as minimally-invasive orthopedic procedures become more commonplace. An 81-year-old female was admitted to the emergency room with syncope. She had reported similar episodes of loss of consciousness and mild dyspnea for a few years prior to hospital admission. In 2008 the patient had undergone percutaneous vertebroplasty due to vertebral compression fractures. Her chest radiograph revealed multiple calcifications along the pulmonary vessels. Pulmonary computed tomography angiography confirmed pulmonary cement embolism. The presence of coexisting thrombus in one of the branches of the pulmonary artery was also revealed. The patient was administered enoxaparin subcutaneously and discharged. After 3 weeks repeat echocardiography showed a slight reduction in the dimensions of the pulmonary artery and its branches. Our case demonstrates that pulmonary cement embolism after percutaneous vertebroplasty may coexist with thrombotic embolus. Screening chest radiography after procedures using medical cement should be considered. Long term anticoagulation seems to be appropriate after pulmonary cement embolism. JRCD 2016; 2 (8): 266–269