Pulmonary cement embolism following balloon kyphoplasty: The impact of a procedural complication in a new era for lung cancer management

Rodrigues,Daniela  Marta; Cunha Machado,Daniela   Patrícia; Campainha Fernandes,Sérgio   André; Paixão Barroso,Ana   Maria

doi:10.3892/mco.2018.1782

Pulmonary cement embolism following balloon kyphoplasty: The impact of a procedural complication in a new era for lung cancer management

Authors:
- Daniela Marta Rodrigues
- Daniela Patrícia Cunha Machado
- Sérgio André Campainha Fernandes
- Ana Maria Paixão Barroso
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Affiliations: Department of Pulmonology, Hospital Pedro Hispano, São Mamede de Infesta, 4465‑120 Matosinhos, Portugal, Multidisciplinary Unit of Thoracic Tumors, Department of Pulmonology, Centro Hospitalar Vila Nova de Gaia/Espinho, 4434‑502 Vila Nova de Gaia, Portugal
Published online on: November 30, 2018 https://doi.org/10.3892/mco.2018.1782
Pages: 299-303

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Abstract

Pulmonary cement embolism (PCE) is a recognized complication of balloon kyphoplasty, a vertebral augmentation technique that stabilizes vertebral compression fractures, alleviating associated pain. Balloon kyphoplasty is particularly relevant when patients with advanced stages of cancer present with longer survival times, and therefore benefit from such augmentation techniques to improve pain and prevent additional complications. The embolization of cement to pulmonary vasculature may be unnoticed given the frequent absence of symptoms and routine imaging tests following the procedure. The present study reports the case of a 58‑year‑old female with stage IV lung cancer with a painful compression L3 fracture who underwent balloon kyphoplasty with no initially reported complications. The patient maintained the usual respiratory symptoms; therefore, the diagnosis was only made in a routine CT scan 3 months after the surgery. A literature review of PCE is performed, integrating the current evidence regarding diagnosis, therapeutics, prognosis and prevention. Certain poorly clarified aspects are identified as potential investigation starting points.

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1	Yimin Y, Zhiwei R, Wei M and Jha R: Current status of percutaneous vertebroplasty and percutaneous kyphoplasty - a review. Med Sci Monit. 19:826–836. 2013. View Article : Google Scholar : PubMed/NCBI
2	Mansour A, Abdel-Razeq N, Abuali H, Makoseh M, Shaikh-Salem N, Abushalha K and Salah S: Cement pulmonary embolism as a complication of percutaneous vertebroplasty in cancer patients. Cancer Imaging. 18:52018. View Article : Google Scholar : PubMed/NCBI
3	Matouk CC, Krings T, Ter Brugge KG and Smith R: Cement embolization of a segmental artery after percutaneous vertebroplasty: A potentially catastrophic vascular complication. Interv Neuroradiol. 18:358–362. 2012. View Article : Google Scholar : PubMed/NCBI
4	Rothermich MA, Buchowski JM, Bumpass DB and Patterson GA: Pulmonary cement embolization after vertebroplasty requiring pulmonary wedge resection. Clin Orthop Relat Res. 472:1652–1657. 2014. View Article : Google Scholar : PubMed/NCBI
5	Krueger A, Bliemel C, Zettl R and Ruchholtz S: Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: A systematic review of the literature. Eur Spine J. 18:1257–1265. 2009. View Article : Google Scholar : PubMed/NCBI
6	Geraci G, Lo Iacono G, Lo Nigro C, Cannizzaro F, Cajozzo M and Modica G: Asymptomatic bone cement pulmonary embolism after vertebroplasty: Case report and literature review. Case Rep Surg. 2013:5914322013.PubMed/NCBI
7	McCall T, Cole C and Dailey A: Vertebroplasty and kyphoplasty: A comparative review of efficacy and adverse events. Curr Rev Musculoskelet Med. 1:17–23. 2008. View Article : Google Scholar : PubMed/NCBI
8	Luetmer MT, Bartholmai BJ, Rad AE and Kallmes DF: Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty. AJNR Am J Neuroradiol. 32:654–657. 2011. View Article : Google Scholar : PubMed/NCBI
9	Kalra A, Sharma A, Palaniswamy C, El-Oshar S, Desai P, Yazbeck M and Zanotti-Cavazzoni SL: Diagnosis and management of bone cement implantation syndrome: Case report and brief review. Am J Ther. 20:121–125. 2013. View Article : Google Scholar : PubMed/NCBI
10	Choe DH, Marom EM, Ahrar K, Truong MT and Madewell JE: Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty. AJR Am J Roentgenol. 183:1097–1102. 2004. View Article : Google Scholar : PubMed/NCBI
11	Kim YJ, Lee JW, Park KW, Yeom JS, Jeong HS, Park JM and Kang HS: Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: Incidence, characteristics, and risk factors. Radiology. 251:250–259. 2009. View Article : Google Scholar : PubMed/NCBI
12	Kollmann D, Hoetzenecker K, Prosch H, Ankersmit HJ, Aigner C, Taghavi S and Klepetko W: Removal of a large cement embolus from the right pulmonary artery 4 years after kyphoplasty: Consideration of thrombogenicity. J Thorac Cardiovasc Surg. 143:e22–e24. 2012. View Article : Google Scholar : PubMed/NCBI
13	Blinc A, Bozic M, Vengust R and Stegnar M: Methyl-methacrylate bone cement surface does not promote platelet aggregation or plasma coagulation in vitro. Thromb Res. 114:179–184. 2004. View Article : Google Scholar : PubMed/NCBI
14	Toru Ü, Coşkun T, Acat M, Onaran H, Gül Ş and Çetinkaya E: Pulmonary cement embolism following percutaneous vertebroplasty. Case Rep Pulmonol. 2014:8515732014.PubMed/NCBI
15	Chen HL, Wong CS, Ho ST, Chang FL, Hsu CH and Wu CT: A lethal pulmonary embolism during percutaneous vertebroplasty. Anesth Analg. 95:1060–1062. 2002. View Article : Google Scholar : PubMed/NCBI
16	Franco E, Frea S, Solaro C, Conti V and Pinneri F: Fatal pulmonary embolism: When the cause is not a thrombus. Spine. 37:E411–E413. 2012. View Article : Google Scholar : PubMed/NCBI
17	Marden FA and Putman CM: Cement-embolic stroke associated with vertebroplasty. AJNR Am J Neuroradiol. 29:1986–1988. 2008. View Article : Google Scholar : PubMed/NCBI
18	Monticelli F, Meyer HJ and Tutsch-Bauer E: Fatal pulmonary cement embolism following percutaneous vertebroplasty (PVP). Forensic Sci Int. 149:35–38. 2005. View Article : Google Scholar : PubMed/NCBI
19	Stricker K, Orler R, Yen K, Takala J and Luginbühl M: Severe hypercapnia due to pulmonary embolism of polymethylmethacrylate during vertebroplasty. Anesth Analg. 98:1184–1186. 2004. View Article : Google Scholar : PubMed/NCBI
20	Yoo KY, Jeong SW, Yoon W and Lee J: Acute respiratory distress syndrome associated with pulmonary cement embolism following percutaneous vertebroplasty with polymethylmethacrylate. Spine. 29:E294–E297. 2004. View Article : Google Scholar : PubMed/NCBI
21	Venmans A, Klazen CA, van Rooij WJ, de Vries J, Mali WP and Lohle PN: Postprocedural CT for perivertebral cement leakage in percutaneous vertebroplasty is not necessary - results from VERTOS II. Neuroradiology. 53:19–22. 2011. View Article : Google Scholar : PubMed/NCBI
22	McGraw JK, Heatwole EV, Strnad BT, Silber JS, Patzilk SB and Boorstein JM: Predictive value of intraosseous venography before percutaneous vertebroplasty. J Vasc Interv Radiol. 13:149–153. 2002. View Article : Google Scholar : PubMed/NCBI
23	Vallabhajosyula S, Sundaragiri PR, Bansal O and Townley TA: A rare nidus for pulmonary thromboembolism after vertebroplasty. BMJ Case Rep. 2013:bcr20132007632013. View Article : Google Scholar : PubMed/NCBI