Non-Healing Radiologic Images of Cement Pulmonary Embolism after Percutaneous Vertebroplasty

Introduction: Percutaneous vertebroplasty is a vertebral augmentation procedure for treatment of painful vertebral fractures usually secondary to osteoporosis. Pulmonary embolism is a rare complication of this procedure and it usually remains undetected because of minor respiratory symptoms. In this report we report our experience with such a case. Case report: A 48-year old male had spontaneous vertebral compression fractures secondary to osteoporosis. This was managed with percutaneous vertebroplasty was for each 11 vertebral body. On the first day after surgery, he described sudden onset of shortness of breath, chest pain and tachycardia. Pulmonary embolism related to cement polymethyl methacrylate (PMMA) was diagnosed after diagnostic evaluation. The patient was treated with low molecular weight heparin (LMWH) and at the end of first week symptoms resolved. The procedure should be terminated if the patient became symptomatic or any leakage is detected. Conclusion: Cement embolism is a complication of percutanous vertebroplasty procedures. Associated symptoms can occur during the procedure or postoperative period. There is no specific standardized treatment protocol, but heparin therapy in emergency situation and warfarin in maintenance therapy are recommended. Anticoagulation may not be effective for resolution of the cement emboli in some cases, but may avoid additional thrombosis. Routine fluoroscopic imagining during and after procedure are suggested for early detection, using viscous cement material and performing venography may reduce the risk of embolism.