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Case Report
Cement pulmonary embolism as a complication of percutaneous vertebroplasty in a patient with follicular lymphoma
1 MD, Department of Internal Medicine, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
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Mariana Guerra
Quinta dos Vales, Coimbra,
Portugal
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Article ID: 100074Z09MG2023
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Guerra M, Peixoto J, Marado D. Cement pulmonary embolism as a complication of percutaneous vertebroplasty in a patient with follicular lymphoma. J Case Rep Images Med 2023;9(1):11–15.ABSTRACT
Vertebroplasty involves injecting a cement polymer, often polymethylmethacrylate (PMA), into the vertebral body under imaging guidance to increase stability. However, the high vascularization and anatomical network of the paravertebral and extradural venous plexuses can allow the migration of cement particles into the systemic venous circulation regardless of whether spinal compression or fractures occur during or are present prior to the treatment. This case report presents a 42-year-old female patient who visited the emergency room with symptoms of cough, nasal obstruction, rhinorrhea, and dyspnea and had a history of follicular non-Hodgkin’s lymphoma under rituximab treatment. Imaging revealed a cement embolism in the pulmonary artery tree, most likely caused by prior vertebroplasty. Anticoagulation was started despite the lack of hypoxemia due to the inorganic character of the embolic substance and the patient’s immunosuppressed status. The embolic debris was still present on subsequent imaging, but the patient’s condition remained stable, with some signs of illness remission. This case highlights the importance of considering cement embolism as a possible vertebroplasty complication and the importance of properly assessing and managing such cases, particularly in patients with underlying medical issues, as well as the need for the development of a standard protocol of sequential chest X-rays after the procedure and possible alternatives to PMA.
Keywords: Cement pulmonary embolism, Metastatic compression fractures, Procedure complications, Vertebroplasty
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Author Contributions
Mariana Guerra - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
João Peixoto - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Daniela Marado - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Mariana Guerra et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
