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

Introduction. Acrylic cement pulmonary embolism is a potentially serious complication following vertebroplasty. Case Report. A70-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 treatedwith enoxaparin, amoxicillin, and dexamethasone. At the followup CT scan no further migration of any cement material wasreported; and the course was uneventful. Discussion. The frequency of local leakage of bone cement is relatively high (about80–90%), moreover, the rate of cement leakage into the perivertebral veins (seen in up to 24% of vertebral bodies treated) withconsequent pulmonary cement embolism varies from4.6 to 6.8% (up to 26% in radiologic studies); the risk of embolism is increasedwith the liquid consistency of the cement and with the treatment of some malignant lesions. Patients may remain asymptomaticand develop no known long-term sequelae. Conclusions. Our ancedotal case illustrates the need for close monitoring of patientsundergoing percutaneous vertebroplasty and emphasizes the importance of prompt and correct diagnosis and treatment, even ifactually there is no agreement regarding the therapeutic strategy.1. IntroductionBone cement embolism is a severe and potentially lifethreateningcomplication of cement (polymethylmethacrylate,PMM) vertebroplasty.We report a case of asymptomatic PMM pulmonaryembolism following a surgical vertebroplasty.2. Case ReportA 70-year-old male patient with a complex medical historyof coronary heart disease and hypertension (bicameral pacemakerdependent, left carotid artery stent, and triple aortocoronarybypass) was admitted to our university hospitalfor osteoporotic nontraumatic vertebral collapse of L5-S1 andspondylotic degeneration of vertebral.Preoperative serum chemistries and electrocardiogramwere normal.