Pulmonary cement embolization after vertebroplasty requiring pulmonary wedge resection

Pulmonary cement embolization after vertebroplasty is a well-known complication but typically presents with minimal respiratory symptoms. Although this rare complication has been reported, the current literature does not address the need for awareness of symptoms of potentially devastating respiratory compromise.

We present the case of a 29-year-old man who underwent T11 vertebroplasty and subsequently had chest pain develop several days later. His right lower lung lobe had infarcted owing to massive cement embolization to his pulmonary arterial circulation. Open pulmonary wedge resection and embolectomy were performed. The patient recovered from the embolectomy but had chronic, persistent respiratory symptoms after surgery.

Operative management of vertebral compression fractures has included percutaneous vertebroplasty for the past 25 years. The reported incidence of pulmonary cement emboli after vertebroplasty ranges from 2.1% to 26% with much of this variation resulting from which radiographic technique is used to detect embolization. Symptoms of pulmonary cement embolism can occur during the procedure, but more commonly begin days to weeks, even months, after vertebroplasty. At least six deaths from cement embolization after vertebroplasty have been reported. Most cases of pulmonary cement emboli with cardiovascular and pulmonary complications are treated nonoperatively with anticoagulation. Endovascular removal of large cement emboli from the pulmonary arteries is not without risk and sometimes requires open surgery for complete removal of cement pieces.

Pulmonary cement embolism is a potentially serious complication of vertebroplasty. If a patient has chest pain or respiratory difficulty after the procedure, chest radiography and possibly advanced chest imaging studies should be performed immediately.