SESSION TITLE: Medical Student/Resident Pulmonary Vascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: In the United States there are over 700,000 new vertebral compression fractures each year.1 While a majority of these can be successfully medically managed, some patients will develop chronic pain and undergo kyphoplasty or vertebroplasty in seek of pain relief. Cement pulmonary embolism is a common adverse event of these frequently performed procedures that clinicians should be familiar with. CASE PRESENTATION: A 63-year-old female presented to the emergency room after developing chest pain and dyspnea that started thirty minutes after a T11-L2 kyphoplasty. Initial vital signs were significant for an oxygen saturation of 88% on room air, heart rate of 111, blood pressure of 133/84, and respiratory rate of 22. On exam the patient was tachycardic and demonstrated decreased breath sounds over the right middle and lower lung fields. Basic laboratory work was significant for a white blood cell count of 13,700 (87% neutrophils), undetectable troponin x 2, and BNP of 60. Chest radiograph showed a small to moderate right pleural effusion with right lower lobe airspace disease. Electrocardiogram demonstrated sinus tachycardia with no ST segment changes. Wells score was six, therefore CT angiography was pursued to evaluate for pulmonary embolism. The CT scan revealed a pulmonary cement embolism involving the subsegmental pulmonary arteries of the bilateral upper lobes with evidence of cement leaking into the azygos and IVC. The patient was admitted to the hospital where she was initially treated with antibiotics for aspiration pneumonia and started on therapeutic dose anticoagulation. She was discharged on two liters of oxygen on hospital day two. She was to continue anticoagulation for six months and complete a five day course of antibiotics. At her two month follow-up her dyspnea and chest pain had completely resolved. DISCUSSION: During kyphoplasty cement is injected into the vertebrae and can leak into the epidural veins and travel through the venous system and lodge in the right ventricle or pulmonary arteries causing a pulmonary cement embolism. This is a reported complication in up to twenty five percent of cases when CT is used as the diagnostic modality.2 Patients can present with chest pain, dyspnea, hypoxia, tachycardia, and even cardiogenic shock and sudden death usually days to weeks after their procedure. Diagnosis can be made with standard chest radiograph however CT is the diagnostic test of choice. Current treatment guidelines are based upon case series and expert opinion. If patients are stable but symptomatic it is recommended that they be anticoagulated for three to six months.3 In cases of hemodynamic instability immediate surgical retrieval of the embolus is recommended.3 CONCLUSIONS: Clinicians should be familiar with the diagnosis and management of pulmonary cement embolism as it is a common adverse event after vertebral augmentation procedures. Reference #1: 1. Riggs BL, Melton LJ. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995;17(5 Suppl):505s–11s. Reference #2: 2. Kim YJ, Lee JW, Park KW, et al. Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors. Radiology. 2009;251(1):250-259. Reference #3: 3. Krueger A, Bliemel C, Zetti R, and Ruchholtz S. Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: systematic review of the literature. Eur Spine J. 2009 Sep; 18(9): 1257–1265. DISCLOSURES: No relevant relationships by Chris Morris, source=Web Response No relevant relationships by Samuel Rafla, source=Web Response