Abstract Introduction Pulmonary cement embolism (PCE) is a relatively rare complication which may occur during percutaneous vertebroplasty and balloon kyphoplasty. Incidence estimates range from 3.5% to 23%. We present a case of PCE following thoracic kyphoplasty. Case Presentation A 70-year-old female with past medical history of severe persistent asthma, hypertension, moderate mitral regurgitation and a T10 vertebral fracture who underwent polymethyl methacrylate kyphoplasty 5 months prior to presentation was evaluated in the pulmonary clinic due to progressive dyspnea and chest tightness at rest and with exertion. Her symptoms were distinct to her asthmatic symptoms, which had been well controlled on inhaled bronchodilators. CT imaging revealed widespread radiopaque densities in the segmental pulmonary arteries of both lungs without evidence of parenchymal lung disease. An echocardiogram revealed normal right heart size, morphology and function, LVEF of 65%, grade 2 diastolic dysfunction, mild tricuspid regurgitation and moderate eccentric mitral regurgitation, stable compared to previous studies. Symptoms were persistent at follow up 6 months later, prompting further evaluation. A Chest CT angiogram was performed which demonstrated embolic disease, with a new distal right lower lobe filling defect and associated peripheral opacity consistent with a pulmonary infarction. Apixaban 5mg twice daily was initiated. The patient was referred to a tertiary care CTEPH center for evaluation, with no further intervention recommended. Discussion The management of PCE is not well established. While most cases are asymptomatic, some patients may develop symptoms due to elevated dead space fraction or due to pulmonary hypertension. Anticoagulation has been recommended for the first 6 months, however the role of long-term anticoagulation is not well established. Cement material can serve as a nidus for further thrombus formation, as seen in this patient. Percutaneous and surgical intervention has been described, with intervention considered in patients with more centrally located PCE and in those who are symptomatic. This abstract is funded by: None
Owens et al. (Fri,) studied this question.