Simultaneous pulmonary and intracardiac bone cement embolism after vertebroplasty: a case report and literature review

Pulmonary embolism (PE) is a major contributor to cardiovascular morbidity and mortality. Pulmonary cement embolism (PCE), a rare form of PE, typically arises from bone cement leakage, a recognized complication of percutaneous vertebroplasty (PVP) and kyphoplasty. To reach the pulmonary artery, cement fragments must first pass through the heart cavities, where some fragments may remain, resulting in intracardiac cement embolism (ICE). Due to its subtle clinical presentation, PCE and ICE may go undetected by clinicians, posing a serious threat to patient safety. We present a rare case of PCE and ICE following PVP caused by bone cement leakage. A 52-year-old woman presented to West China Hospital of Sichuan University with symptoms of dyspnea and chest tightness. She had a history of undergoing PVP for vertebral fracture (L4). PCE and ICE were confirmed through computed tomography pulmonary angiography and echocardiogram. The patient underwent open-heart surgery and showed a good recovery after a six-month follow-up. This case highlights the crucial importance of clinical vigilance for both pulmonary and intracardiac cement embolism in patients presenting with respiratory or cardiac symptoms following vertebroplasty. Our experience demonstrates the essential role of prompt diagnosis through CTPA and echocardiography, while confirming that open-heart surgery can effectively manage life-threatening intracardiac cement emboli. These findings emphasize the value of systematic post-procedural monitoring when cement embolism is suspected, providing important clinical insights for managing this rare but serious complication.