Pulmonary arterial cement embolization: a rare complication of vertebroplasty

A 73-year-old male presented with slowly progressive dyspnea and no other complaints. The clinical examination was unremarkable, apart from lumber spine orthopedic fixation and vertebroplasty procedure that were performed 7 months prior to this presentation. The posteroanterior and lateral chest radiographs revealed high-density tubular and branching structures, radiating from the hila (arrows in Figures 1 and 2). A maximum intensity projection computed tomography image confirmed that the dense abnormalities are related to the pulmonary arteries (arrows in Figure 3). A lateral lumber spine radiograph confirmed the presence of orthopedic fixation hardware and vertebroplasty (arrow in Figure 4), along with cement embolization into adjacent lumbar veins (arrowhead in Figure 4). This example highlights a rare complication of the vertebroplasty procedure in the form of non-thrombotic pulmonary arterial cement emboli. Cardiopulmonary manifestations of cement embolization may be treated conservatively, with anticoagulation or by partial surgical lung resection.¹ The patient was treated conservatively and persisted to have mild non-limiting dyspnea.

Figure 1.

Posteroanterior chest radiograph showing high-density tubular and branching structures that radiate from the hila (arrows).

Figure 2.

Lateral chest radiograph showing the same high-density tubular and branching material (arrows).

Figure 3.

Maximum intensity projection computed tomography image confirms the presence of high-density material within the pulmonary arteries (arrows).

Figure 4.

Lumber spine radiograph showing orthopedic fixation hardware and vertebroplasty (arrow), along with cement embolization into lumbar veins (arrowhead).