Abstract Introduction Cement pulmonary embolism (CPE) is a rare but recognized complication of vertebral procedures involving bone cement. Although often asymptomatic and detected incidentally, CPE may present with dyspnea, cough, or chest pain. Due to its variable and delayed presentation, CPE may be overlooked in the clinical evaluation of respiratory symptoms. Here, we present a case of symptomatic CPE diagnosed one year after spinal fusion using CAS, emphasizing the need for clinical vigilance in patients with unexplained pulmonary complaints and a history of cement-based spinal procedures. Description of Case A 68-year-old female patient presented to the clinic complaining of chronic cough onset 7 months prior associated with shortness of breath, weight loss, and decreased appetite. Patient was a non-smoker and denied dyspepsia or esophagitis symptoms. An initial chest radiograph was ordered, which showed chronic slightly hyperexpanded lungs with minor linear stranding in the medial left lung, favoring atelectasis or chronic scarring. Due to the patient’s concerning symptoms, and abnormal chest radiograph, a high resolution CT chest scan was ordered. The CT scan demonstrated multiple high-density filling defects in multiple pulmonary arteries bilaterally, compatible with multiple cement emboli. On further discussion, the patient had a laminectomy with lumbar fusion 1 year before her symptoms onset. Review of the operative report yielded a laminectomy and posterior lumbar interbody fusion L4-L5 which noted the use of CAS during spinal fusion. Patient was diagnosed with chronic CPE and started on Apixaban for 3 months with a plan to obtain a transthoracic echocardiogram (TTE) to identify intracardiac emboli and possible right ventricular strain. Discussion CPE is a rare but recognized complication of spinal procedures. Asymptomatic and symptomatic CPE occur in approximately 6% and 1.3% of patients, respectively, following the use of CAS. Leakage of bone cement into the venous system can lead to pulmonary embolization. This may be discovered incidentally in asymptomatic patients on imaging or symptomatic patients with dyspnea, cough, chest pain, or cardiac arrest. There are no current guidelines for the treatment of CPE. CPE is not shown to be directly thrombotic, and treatment is usually reserved for symptomatic patients. Heparin and direct oral anticoagulants are most commonly used. This rare case shows symptomatic CPE presenting a year after spinal surgery. Given the potentially life-threatening nature of CPE, it is critical to consider this pathology in the differential diagnosis of patients with cardiopulmonary symptoms with a history of associated vertebral cement-based procedures. This abstract is funded by: None
Sundin et al. (Fri,) studied this question.