ABSTRACT
Pulmonary cement embolism is a rare complication of vertebroplasty. We report an 81‐year‐old man with idiopathic pulmonary fibrosis presenting with respiratory failure, 18 months post‐vertebroplasty. CT revealed a hyperdense pulmonary artery embolus, underscoring the importance of vigilance for delayed vertebroplasty complications.
Keywords: Interstitial lung disease, pulmonary cement embolism, vertebroplasty
Pulmonary cement embolism is an uncommon but potentially serious complication of vertebroplasty caused by polymethylmethacrylate leakage into the venous system and pulmonary circulation. Management is individualised, ranging from observation in asymptomatic cases to anticoagulation or surgical intervention for large or symptomatic emboli.
An 81‐year‐old man, a non‐smoker with a history of idiopathic pulmonary fibrosis, presented with a 5‐day history of progressive dyspnoea, dry cough and fatigue. On physical examination, he was tachypneic with bilateral fine crackles. A chest radiograph revealed bilateral reticular opacities and a dense opacity in the right hilum (Figure 1A, white arrow). He had undergone vertebroplasty with spinal fixation and cementing 18 months earlier for an osteoporotic vertebral compression fracture. Given the suspicion of an acute exacerbation of idiopathic pulmonary fibrosis (IPF) and the need to exclude pulmonary cement embolism, a computed tomography pulmonary angiogram (CTPA) was done. CTPA showed no thrombus; however, on a non‐contrast window, a hyperdense material (Hounsfield unit: 3476) was visualised in the lower lobar branch of the right pulmonary artery (Figure 1B, asterisk). Bilateral ground glass opacities and reticulations were also noted on the lung window. High‐density material was also visualised within the D11 and D12 vertebral bodies (Figure 1C, white arrows). A diagnosis of pulmonary cement embolism with acute exacerbation of IPF was made. After hospitalisation, the patient was initially managed with high‐flow nasal cannula (HFNC) oxygen therapy and supportive care. However, his respiratory status subsequently deteriorated, requiring mechanical ventilation, which the patient and family declined [1, 2].
FIGURE 1.
(A) Chest radiograph showing bilateral reticular opacities and a dense opacity in the right hilum (white arrow). (B) CT image coronal view showing a hyperdense material in the right pulmonary artery (asterisk), consistent with cement embolism. (C) CT sagittal view showing high‐density material in D11 and D12 vertebrae (white arrows), indicating prior vertebroplasty.
Author Contributions
Randeep Singh: literature search, drafted the manuscript and final revision. Kawleen Kour: drafted the manuscript and contributed to revision. Harkirat Singh Panaych: drafted the manuscript and contributed to revision. All authors reviewed and approved the final manuscript.
Consent
Written informed consent for publication of this case and accompanying images was obtained from the patient's family using the Respirology Case Reports patient consent form.
Conflicts of Interest
The authors declare no conflicts of interest.
Singh R., Kour K., and Panaych H. S., “Pulmonary Cement Embolism After Vertebroplasty,” Respirology Case Reports 13, no. 9 (2025): e70343, 10.1002/rcr2.70343.
Associate Editor: Manuel Peter Paul Cabal Jorge
Funding: The authors received no specific funding for this work.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.