Acute Massive Pulmonary Thromboembolism from Bone Cement Leakage Post-PVP

Overview

This case study reports a rare instance of acute massive pulmonary thromboembolism caused by bone cement leakage into the heart and pulmonary arteries following percutaneous vertebroplasty (PVP). Imaging confirmed cord-like foreign bodies originating from the vertebra, and aggressive thrombolytic therapy led to symptomatic improvement despite persistent foreign bodies on follow-up.

Background

Percutaneous vertebroplasty (PVP) is a minimally invasive procedure used to treat vertebral compression fractures, often due to osteoporosis, by injecting bone cement into the vertebra. Bone cement leakage is a known complication, but cardiopulmonary cement embolism (CPCE) is extremely rare, occurring in approximately 3.36% of cases, with symptomatic embolism even less frequent. CPCE can lead to cardiopulmonary embolism through direct embolization or secondary thrombosis induced by the porous cement structure. Few cases have documented acute massive pulmonary thromboembolism secondary to bone cement leakage.

Data Highlights

Key Findings

• Bone cement leakage after PVP can extravasate into the vertebral venous system, reaching the heart and pulmonary arteries as cord-like foreign bodies.
• These foreign bodies can induce acute massive pulmonary thromboembolism with secondary thrombosis, a rare but life-threatening complication.
• Computed tomography pulmonary angiography (CTPA) combined with 3D reconstruction is critical for identifying the origin and extent of cement emboli.
• Lower extremity ultrasonography is essential to exclude deep venous thrombosis as an embolism source.
• Emergency catheter-directed thrombolysis followed by anticoagulation therapy can lead to rapid symptomatic improvement despite persistent foreign bodies on imaging.

Clinical Implications

Clinicians should maintain a high index of suspicion for cardiopulmonary cement embolism in patients presenting with acute pulmonary embolism symptoms shortly after PVP. Prompt imaging with CTPA and 3D reconstruction aids diagnosis and guides management. Early aggressive thrombolytic therapy combined with anticoagulation can improve outcomes, although residual cement emboli may persist radiographically.

Conclusion

Acute massive pulmonary thromboembolism secondary to bone cement leakage after PVP is a rare but serious complication. Early recognition and intervention with thrombolysis and anticoagulation are crucial for favorable patient outcomes.

References

1. AHA/ACC Guidelines 2019 -- Evaluation and Management of Acute Pulmonary Embolism in Adults