Clinical Scorecard: Acute Massive Pulmonary Thromboembolism Induced by Cord-like Foreign Bodies in the Heart and Pulmonary Arteries Following Percutaneous Vertebroplasty: A Case Study and Review of Relevant Literature

At a Glance

Key Highlights

• Bone cement leakage after percutaneous vertebroplasty can rarely cause cardiopulmonary cement embolism (CPCE) with an incidence of 3.36%, symptomatic cases even rarer (0.32%).
• Cord-like foreign bodies originating from vertebral bone cement can traverse venous pathways into the heart and pulmonary arteries causing acute massive pulmonary thromboembolism.
• Emergency catheter-directed thrombolysis combined with postoperative anticoagulation can improve symptoms, though foreign bodies may persist on imaging.

Guideline-Based Recommendations

Diagnosis

• Use computed tomography pulmonary angiography (CTPA) with three-dimensional reconstruction to identify foreign bodies and thromboembolism.
• Exclude deep venous thrombosis (DVT) via lower extremity vascular ultrasonography.
• Consider patient history of recent percutaneous vertebroplasty when evaluating unexplained pulmonary embolism.

Management

• Initiate urgent catheter-directed thrombolysis for acute massive pulmonary embolism with hemodynamic instability (grade E1).
• Administer postoperative anticoagulant therapy for at least 3 months following thrombolysis.
• Multidisciplinary consultation including interventional radiology and respiratory medicine is recommended.

Monitoring & Follow-up

• Monitor oxygen saturation and hemodynamic parameters closely during acute management.
• Repeat imaging (CTPA) post-treatment to assess persistence of foreign bodies and thrombus resolution.
• Regular clinical follow-up to evaluate symptom improvement and anticoagulation efficacy.

Risks

• Bone cement leakage can cause non-thrombotic foreign body embolism leading to cardiopulmonary complications.
• Secondary thrombosis may develop on porous bone cement emboli, increasing embolic burden.
• Hemodynamic instability and cardiogenic shock may occur in massive pulmonary embolism cases.

Patient & Prescribing Data

66-year-old female patient with osteoporosis-related vertebral fracture treated by percutaneous vertebroplasty

Subcutaneous enoxaparin sodium (4,000 IU) initiated immediately; catheter-directed thrombolysis performed emergently; postoperative anticoagulation continued for 3 months with symptomatic improvement despite persistent foreign body on imaging

Clinical Best Practices

• Consider bone cement embolism in differential diagnosis of pulmonary embolism after vertebroplasty.
• Employ advanced imaging techniques including 3D CT reconstruction to trace foreign body origin and extent.
• Urgent thrombolytic therapy is indicated in hemodynamically unstable patients with massive pulmonary embolism.
• Exclude other embolic sources such as DVT to confirm diagnosis.
• Maintain multidisciplinary approach for diagnosis, intervention, and postoperative care.

References

• AHA/ACC Guidelines for the Evaluation and Management of Acute Pulmonary Embolism in Adults