Severe Pulmonary Cement Embolism

Abstract

A 57-year-old man presented with dyspnea and chest pain for 3 days, but he did not have fever, cough, or hemoptysis. Two weeks prior, he underwent vertebroplasty in the thoracic-lumbar spine. Upon arrival, he had the following vital signs: body temperature of 36.5°C, pulse rate of 115 beats/min, respiratory rate of 24 breaths/min, and blood pressure of 153/95 mm Hg. Physical examination showed that breath sounds were normal bilaterally, and there was no tenderness in the chest wall. Chest radiography revealed several linear hyperdense opacities at the bilateral pulmonary arteries (Figure 1, arrows), and further computed tomography of the chest confirmed the diagnosis of pulmonary cement embolism (Figure 2). Therefore, low-molecular-weight heparin with enoxaparin 60 mg every 12 h was given, but in vain. Due to persistent dyspnea, surgical intervention for removing pulmonary cement embolism was arranged. During the operation, a stripe-like material 18 cm in length and 2 mm in width was noted in the bifurcation of the pulmonary artery. The postoperative course went smoothly, and he was discharged uneventfully 2 weeks later. Figure 2Computed tomography of the chest showed the bone cement within the pulmonary artery (arrows). View Large Image Figure Viewer Download Hi-res image