A Shadow in the Right Ventricle

Intracardiac cement embolism (ICE) is a rare but potentially lethal complication of percutaneous vertebroplasty (PVP), often misdiagnosed as conventional thrombotic pulmonary embolism (PE) due to similar clinical presentations and elevated D-dimer levels.

A 65-year-old woman presented to the emergency department with chest tightness and dyspnea 15 days after undergoing multilevel PVP. Initial D-dimer elevation suggested acute PE. However, point-of-care ultrasound (POCUS) revealed a linear hyperechoic structure with dense posterior acoustic shadowing in the right ventricle, distinguishing it from a soft thrombus. A chest CT confirmed bone cement embolism. The patient underwent successful surgical embolectomy and was discharged without complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ICE must be considered in patients presenting with cardiopulmonary symptoms following spinal interventions. Unlike thrombotic PE, ICE carries unique risks, such as cardiac perforation, and often requires surgical or endovascular retrieval rather than standard anticoagulation.

POCUS is a rapid and critical bedside tool for identifying mineralized foreign bodies like bone cement, facilitating prompt and appropriate management in the emergency department.