CRA58 PULMONARY CEMENT EMBOLISM: A COMPLICATION OF POSTERIOR SPINAL INSTRUMENTATION AND FUSION

Afifah Kamarudin1, Noor Eliana Rozani1, Raymund Dass1, Han Loong Tan1
1 Respiratory Unit, Department of Internal Medicine, Hospital Tuanku Ja’afar Seremban, Malaysia

Introduction

Pulmonary cement embolism (PCE) is a rare complication of vertebroplasty surgery whereby the cement leaks into the paravertebral veins and subsequently into the pulmonary arteries following cement augmentation. Choices of treatment for PCE from current available literature include pain management, anticoagulation, embolectomy, and supportive care. 

Case Report

A 35 years old lady with underlying left breast carcinoma with metastases to spine and pathological fracture of L2 with history of posterior spinal instrumentation and fusion of T9 - L2 done in February 2023 was admitted to the ward in November 2023. She presented with pleuritic chest pain which does not resolve with analgesic taken at home. Initially she was treated as having breakthrough pain secondary to spine metastases, however despite optimizing pain control her pain does not improve. CTPA was done to exclude pulmonary embolism and the result shows hyperdensity seen at T9 to T11 and L1 vertebra in keeping with bone cement with occasional hyperdensities of tubular and branching shape seen within the segmental and small branches of the pulmonary arteries bilaterally. There was similar hyperdensity also seen within the right atrium, measuring 1.3 x 0.8 x 1.5cm. She was diagnosed to have pulmonary cement embolism and was referred to the respiratory team. She was treated symptomatically with paracetamol, morphine, celebrex and tramal and her symptoms improved. As she has no respiratory compromise, supportive care has been shown to be an effective modality and can avoid risk of anticoagulation or embolectomy. 

Conclusion

Treatment of PCE depends on patient’s clinical status as not all PCE requires anticoagulation or embolectomy.