Cement pulmonary embolism as a complication of percutaneous vertebroplasty in a patient with follicular lymphoma

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.