Case report demonstrating radiological progression of polymethylmethacrylate distribution in asymptomatic pulmonary cement embolism

This case report describes a 50-year-old male with metastatic colorectal carcinoma and pathological fractures of T4 and T8 vertebrae, subsequently managed with vertebroplasty. Post-operative day one chest radiograph revealed polymethylmethacrylate (PMMA) extravasation into the azygos vein, but not in pulmonary arteries. Follow-up radiograph in one week showed progressive radiological migration of PMMA into bilateral pulmonary arteries, confirmed by contrast-enhanced computed tomography. The patient remained asymptomatic all along and was under conservative management. Stable cement distribution was maintained afterwards for 5 years. This case highlights the rarely reported radiological progression of cement pulmonary embolism in asymptomatic patient, discusses potential mechanisms and management strategies.