SHM Converge Scientific Abstract ePoster Gallery-Cementing the Diagnosis in a Patient With Shortness of Breath

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This case report describes the youngest reported symptomatic pulmonary cement embolism (PCE) after vertebral kyphoplasty. A 32-year-old woman with multiple chronic conditions, including mast cell activation syndrome, asthma, Ehlers-Danlos syndrome, fibromyalgia, and steroid-induced osteopenia, initially underwent T4–T7 kyphoplasty for thoracic compression fractures. Although her immediate postoperative course was uncomplicated, she returned two weeks later with persistent chest pain, back pain, and shortness of breath. Imaging confirmed cement emboli in the right main pulmonary artery extending into the right middle lobe pulmonary artery and azygos vein.<br /><br />She was initially treated with partial mechanical thrombectomy and discharged on lifelong anticoagulation. Because symptoms persisted, she later presented to the authors’ institution for further evaluation. On admission, she had tachycardia, chest wall and thoracic tenderness, and mild hypoxemia, but no evidence of right heart strain on echocardiogram. CT angiography again showed retained cement emboli, and she also had new T8 and T9 compression deformities.<br /><br />Given ongoing exertional dyspnea, chest discomfort, and concern for long-term complications, thoracic surgery performed pulmonary thromboendarterectomy to remove the cement material. Postoperative imaging showed cleared vasculature and removal of the embolus.<br /><br />The report highlights that vertebral kyphoplasty, while useful for stabilizing fractures and relieving pain, carries risks including cement leakage, new vertebral fractures, adjacent-level fractures, and rare symptomatic PCE. The authors emphasize that untreated pulmonary cement emboli may lead to chronic hypoxemia, right ventricular strain, respiratory failure, and chronic thromboembolic pulmonary hypertension. They conclude that invasive intervention is rarely needed but may be required in selected symptomatic patients, and that more research is needed on long-term outcomes, especially in younger adults with complex medical histories.

Asset Subtitle

Daniel D. Dressler

Meta Tag

Author List Alexander Pressman, Aubrey C. Reed, Christian Devlin, Daniel D. Dressler

Category Clinical Vignettes

Concept Vertebral kyphoplasty

Concept Pulmonary cement embolism

Concept Vertebral compression fracture

Concept Cement leakage

Concept Pain Relief

Distinguished Non-Finalist

Presenter Organization Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine

Presenting Author Daniel D. Dressler

Track Adult

Keywords

pulmonary cement embolism

vertebral kyphoplasty

kyphoplasty complications

cement emboli

pulmonary artery

thromboendarterectomy

thoracic compression fractures

shortness of breath

anticoagulation

Ehlers-Danlos syndrome

Vertebral kyphoplasty

Pulmonary cement embolism

Vertebral compression fracture

Cement leakage

Pain Relief