SESSION TITLE: Variety in Risk Factors and Treatment of VTESESSION TYPE: Rapid Fire Case ReportsPRESENTED ON: 10/19/2022 12:45 pm - 1:45 pmINTRODUCTION: Vertebral kyphoplasties are a common treatment for osteoporotic compression fractures. They are considered safe but not devoid of side effects, a common one being leakage of the cement (polymethyl methacrylate (PMMA)), resulting in a pulmonary cement embolism (PCE). While standard treatment for thromboembolic pulmonary embolism (PE) is anticoagulation, it is unclear how to treat PCE. We present a case of PCE resulting from a kyphoplasty and our treatment approach.CASE PRESENTATION: Patient is a 59 year old male with a history of COPD s/p endobronchial valve placement in the right upper lobe, osteoporosis, vertebral compression fractures at T6, T8 s/p kyphoplasty x3, who presented with cough, hemoptysis, pleuritic chest pain, shortness of breath. He underwent kyphoplasty 3 days ago. Vitals revealed tachycardia, otherwise unremarkable. Chest x-ray showed foreign body material and multiple emboli in the lung parenchyma concerning for PCE (Image 1). CTA Chest revealed scattered hyperdense foreign body material in the azygos system and throughout the peripheral lung parenchyma bilaterally consistent with PCE (Images 2-6). He also tested positive for adenovirus. The decision was made to provide supportive care. After 7 days, his symptoms improved and he was discharged.DISCUSSION: Currently no evidence-based treatment exists for PCE. Asymptomatic PCE typically require observation and follow-up. Symptomatic PCEs tend to be anticoagulated based on thromboembolic PE guidelines. If significant cement burden exists, thrombectomy is an option. While most clinicians follow standard anticoagulation guidelines for thromboembolic PE, the role of anticoagulation in PCE is unclear. PMMA has been shown to have no procoagulant effects nor inhibit antithrombotic mechanisms on the endothelium. Additionally, other non-thrombotic emboli, such as fat and amniotic fluid emboli, are not treated with anticoagulation, only stabilization and supportive care.Our patient was not a candidate for thrombectomy due to his hemodynamic stability, mild symptoms, and emboli being scattered peripherally in both lungs (i.e., no retrievable thrombus). His symptoms may have also been exacerbated by his adenovirus infection. As there is no strong evidence to recommend anticoagulation in treating PCE, we opted for a conservative approach. We chose not to anticoagulate as PCE is an inorganic material as the risks outweigh the potential benefits. Our case adds to the sparse literature regarding PCE treatment, illustrating that supportive care is an effective treatment option.CONCLUSIONS: Supportive care is an effective treatment for PCE. Physician's should weigh the benefits versus risks regarding other treatment modalities in symptomatic patients.Reference #1: Zhang J-dong, Poffyn B, Sys G, Uyttendaele D. Comparison of vertebroplasty and kyphoplasty for complications. Orthopaedic Surgery. 2011;3(3):158-160. doi:10.1111/j.1757-7861.2011.00141.xReference #2: Kang H-R, Kim T-H, Chung CK, Lee C-H. The impact of incidental pulmonary cement embolism on mortality risk. Journal of Thrombosis and Thrombolysis. 2020;49(3):468-474. doi:10.1007/s11239-019-02027-0Reference #3: Krueger A, Bliemel C, Zettl R, Ruchholtz S. Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: A systematic review of the literature. European Spine Journal. 2009;18(9):1257-1265. doi:10.1007/s00586-009-1073-yDISCLOSURES: No relevant relationships by Omar KhorfanNo relevant relationships by Brette SmithNo relevant relationships by Joanna Wieckowska SESSION TITLE: Variety in Risk Factors and Treatment of VTE SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Vertebral kyphoplasties are a common treatment for osteoporotic compression fractures. They are considered safe but not devoid of side effects, a common one being leakage of the cement (polymethyl methacrylate (PMMA)), resulting in a pulmonary cement embolism (PCE). While standard treatment for thromboembolic pulmonary embolism (PE) is anticoagulation, it is unclear how to treat PCE. We present a case of PCE resulting from a kyphoplasty and our treatment approach. CASE PRESENTATION: Patient is a 59 year old male with a history of COPD s/p endobronchial valve placement in the right upper lobe, osteoporosis, vertebral compression fractures at T6, T8 s/p kyphoplasty x3, who presented with cough, hemoptysis, pleuritic chest pain, shortness of breath. He underwent kyphoplasty 3 days ago. Vitals revealed tachycardia, otherwise unremarkable. Chest x-ray showed foreign body material and multiple emboli in the lung parenchyma concerning for PCE (Image 1). CTA Chest revealed scattered hyperdense foreign body material in the azygos system and throughout the peripheral lung parenchyma bilaterally consistent with PCE (Images 2-6). He also tested positive for adenovirus. The decision was made to provide supportive care. After 7 days, his symptoms improved and he was discharged. DISCUSSION: Currently no evidence-based treatment exists for PCE. Asymptomatic PCE typically require observation and follow-up. Symptomatic PCEs tend to be anticoagulated based on thromboembolic PE guidelines. If significant cement burden exists, thrombectomy is an option. While most clinicians follow standard anticoagulation guidelines for thromboembolic PE, the role of anticoagulation in PCE is unclear. PMMA has been shown to have no procoagulant effects nor inhibit antithrombotic mechanisms on the endothelium. Additionally, other non-thrombotic emboli, such as fat and amniotic fluid emboli, are not treated with anticoagulation, only stabilization and supportive care. Our patient was not a candidate for thrombectomy due to his hemodynamic stability, mild symptoms, and emboli being scattered peripherally in both lungs (i.e., no retrievable thrombus). His symptoms may have also been exacerbated by his adenovirus infection. As there is no strong evidence to recommend anticoagulation in treating PCE, we opted for a conservative approach. We chose not to anticoagulate as PCE is an inorganic material as the risks outweigh the potential benefits. Our case adds to the sparse literature regarding PCE treatment, illustrating that supportive care is an effective treatment option. CONCLUSIONS: Supportive care is an effective treatment for PCE. Physician's should weigh the benefits versus risks regarding other treatment modalities in symptomatic patients. Reference #1: Zhang J-dong, Poffyn B, Sys G, Uyttendaele D. Comparison of vertebroplasty and kyphoplasty for complications. Orthopaedic Surgery. 2011;3(3):158-160. doi:10.1111/j.1757-7861.2011.00141.x Reference #2: Kang H-R, Kim T-H, Chung CK, Lee C-H. The impact of incidental pulmonary cement embolism on mortality risk. Journal of Thrombosis and Thrombolysis. 2020;49(3):468-474. doi:10.1007/s11239-019-02027-0 Reference #3: Krueger A, Bliemel C, Zettl R, Ruchholtz S. Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: A systematic review of the literature. European Spine Journal. 2009;18(9):1257-1265. doi:10.1007/s00586-009-1073-y DISCLOSURES: No relevant relationships by Omar Khorfan No relevant relationships by Brette Smith No relevant relationships by Joanna Wieckowska