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Clinical Pearl

Pulmonary Cement Embolism

doi: 10.1097/01.EEM.0000734624.06857.f3


    Percutaneous vertebroplasty and kyphoplasty are commonly performed for compression fractures of the spine. These procedures introduce a cement polymer into the vertebral body, which can cause pulmonary cement embolism (PCE). Cement embolization occurs via leakage of cement into the valveless vertebral venous plexus, from where cement enters the thoracic venous system, or via retrograde migration into the aorta via the arterial channels.

    The majority of cases of PCE occur within days or weeks of the procedure, but they appear immediately in certain cases. Most cases of PCE remain asymptomatic, but serious and fatal outcomes have been reported.

    No standardized therapeutic approach exists for PCE, and available evidence is primarily based on published case reports. A proposed treatment algorithm suggests only close follow-up for asymptomatic peripheral emboli. (Mol Clin Oncol. 2019;10[2]:299;; Respir Med Case Rep. 2019;28:100887;; Asian Spine J. 2018;12[2]:380;

    Patients with symptomatic peripheral embolism or asymptomatic central embolism are treated with heparinization. Surgical embolectomy is considered for symptomatic central embolism.

    The utility of anticoagulation for PCE is uncertain because acrylic cement does not appear to have intrinsic thrombogenic properties or to activate coagulation in vitro. (Mol Clin Oncol. 2019;10[2]:299;; J Thorac Cardiovasc Surg. 2012;143[4]:e22; The turbulent flow caused by the cement, however, has been suggested to promote prothrombotic mechanisms and vascular damage.

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