Pulmonary Cement Embolism Following Vertebroplasty: A Case Series from Incidental Detection to Fatal Outcome

Background and Clinical Significance: Pulmonary cement embolism (PCE) is a recognized complication of vertebral augmentation, with presentations ranging from incidental radiological findings to severe cardiopulmonary compromise. This case series illustrates the clinical importance of assessing embolus distribution together with symptoms and hemodynamic status; Case Presentation: Three women aged 65, 84, and 55 years were diagnosed with PCE following vertebroplasty for osteoporotic or metastatic vertebral compression fractures. In the first patient, predominantly peripheral cement emboli were detected incidentally five years after vertebroplasty, and no PCE-specific treatment was undertaken. The second patient developed chest pain, dyspnea, and cough 15 days after vertebroplasty. Despite extensive pulmonary cement deposition, she remained hemodynamically stable and received apixaban. The third patient presented with severe cardiopulmonary deterioration 20 days after a second vertebroplasty procedure. CT demonstrated subtotal right pulmonary artery obstruction and intracardiac cement. Despite intensive supportive treatment and unfractionated heparin, she died before mechanical removal could be performed. Paravertebral venous cement leakage was identified on CT in both symptomatic patients; Conclusions: These cases illustrate the variable clinical consequences of PCE and the importance of integrating clinical assessment with imaging findings. The intervals to presentation or detection do not establish the timing of embolization. Previous vertebral augmentation should remain relevant when investigating unexplained cardiopulmonary symptoms, even when the procedure was not recent.