Delayed Trans-Tricuspid Intracardiac Cement Embolism After Vertebroplasty: A Case Report With Conservative Management

Abstract Background Intracardiac cement embolism (ICE) is a rare but potentially fatal complication of percutaneous vertebroplasty (PVP). Delayed presentation with initially negative postoperative imaging is particularly challenging. The novelty and clinical implications of this case are reported. Case presentation: A 70-year-old man developed chest tightness and exertional dyspnoea three months after L3 PVP for an osteoporotic compression fracture. Early postoperative chest CT had shown no evidence of pulmonary or intracardiac cement embolism. Transthoracic echocardiography demonstrated a linear hyperechoic structure traversing the tricuspid valve from the right atrium to the right ventricle, with minimal mobility and mild tricuspid regurgitation. Repeat contrast-enhanced chest CT confirmed a linear hyperattenuating cement embolus extending across the tricuspid valve. The embolus had contact points with the right atrial and right ventricular walls and showed minimal mobility, with preserved right ventricular systolic function and no cardiac perforation, pericardial effusion, or haemodynamic compromise. After multidisciplinary assessment, conservative management was selected. At six months after diagnosis, symptoms had resolved and serial echocardiography showed no change in the embolus. Conclusions Delayed intracardiac cement embolism should be considered in patients with new cardiopulmonary symptoms after vertebral augmentation even when early postoperative imaging is negative. In selected patients with a minimally mobile, stable embolus, preserved cardiac function, and no major cardiac complications, conservative management with careful follow-up may be considered.