Percutaneous Removal of Cement Extending to the Right Atrium and Causing Pulmonary Embolism After Percutaneous Vertebroplasty: A Case Report

Percutaneous vertebroplasty is a minimally invasive procedure injecting polymethylmethacrylate cement to increase vertebral stability in vertebral compression fractures. We present a patient who presented with recurrent pulmonary embolism due to intracardiac cement embolism after vertebroplasty with successful percutaneous cement removal. A 72-year-old woman presented with chest pain, dyspnea, hypotension, and atrial fibrillation 1 month after vertebroplasty. Transthoracic echocardiography revealed a freely mobile hyperechoic linear structure in the right atrium; estimated pulmonary artery systolic pressure was 45 mmHg. Computed tomography angiography demonstrated a cement cast extending from L2 vertebra through the inferior vena cava into the right atrium and cement emboli in distal pulmonary arterial branches. Intracardiac cement was successfully removed using a three-lobed snare with balloon assist. Intracardiac cement embolism is a rare, potentially life-threatening complication following vertebroplasty. Percutaneous removal may be considered a safe and effective alternative to open surgery in selected patients.