Cement pulmonary embolism after percutaneous vertebroplasty in a patient with cushing's syndrome: A case report

Abstract

BackgroundVertebroplasty is a procedure most commonly used for vertebral compression fractures. Although it is a relatively safe procedure, complications have been reported. Cement embolism is seen in 2.1%–26% of patients after percutaneous vertebroplasty.Case presentationa 38-year-old male who was diagnosed with cushing's syndrome, underwent percutaneous vertebroplasty for his thoracic osteoporotic compression fractures. 24-hours following vertebroplasty, he presented to emergency department with acute-onset dyspnea and chest pain. Chest radiography showed an opaque linear lesion in left pulmonary artery which was suggestive of cement embolism. Pulmonary spiral CT-scan further confirmed the diagnosis. The patient's symptoms improved over time, and warfarin was started with close cardiopulmonary assessments for indicators of cement embolus removal.Conclusionin patients with pulmonary cement embolism, conservative treatment may be recommended rather than a surgical removal except when the obstruction is extensive enough to cause hemodynamic changes. Given that all the related studies have suggested that pulmonary thromboembolism can occur as a complication due to bone cement leakage, discovering new cement alternatives and/or injection devices, seems beneficial.

Diagnosis of pulmonary cement embolism using only the bone window setting on computed tomography: a case report

“…Although early mortality has been reported in patients with acute PCE, an autopsy study revealed that none of the patients had died due to the impact of PCE. 1,2,7,10,11,13,14 Our patient showed mild symptoms with pulmonary hypertension due to chronic peripheral PCE. Therefore, we started treatment with diuretics.…”

“…Common clinical signs and symptoms include dyspnea, cyanosis, palpitation, chest pain or tightness, and acute respiratory distress syndrome in rare cases. 10,11 These symptoms rarely occur immediately after PVP; most symptoms occur later, sometimes weeks or months after PVP. 1,2,12 Therefore, it is generally difficult to recognize asymptomatic PCE.…”

“…2 Conservative treatment or clinical follow-up and anticoagulation represent the cornerstones of treatment, but some reports have described symptomatic patients with central embolisms requiring surgical removal. 2,10 The rationale for anticoagulation is to reduce the risk of thrombus formation due to the thrombogenic nature of the cement. However, no data support the formation of thrombi on the cement.…”

Multilevel Percutaneous Vertebroplasty with the Spine Jack® system in a patient with Cushing disease

“…The risk of cement leaking outside the vertebral body is unpredictable [18]; According to recent results, the rates of cement leaking may reach 65% [19]. Major complications can be cement embolism as Rahimi reported a case in 2018 [20].…”

Comparison of early results of Vesselplasty and percutaneous vertebroplasty in the treatment of elderly patients with osteoporotic vertebral compression fracture

“…Sarah et al [31] through the analysis of 1512 single center and retrospective cases, it was found that the probability of cement embolism in PVP operation was 3.9%, and the proportion with clinical symptoms was 0.3%. Besharat et al [32] suggested that patients with bone cement pulmonary embolism should be treated conservatively in other cases unless the embolic range is wide and hemodynamic changes are caused. The leakage of bone cement is related to many factors.…”