SHM Converge Scientific Abstract ePoster Gallery-Pain in the Neck: Cement Embolism

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This case report describes a man in his early 60s with metastatic pancreatic cancer who developed sudden, severe lower neck pain two weeks after undergoing T3-T4 kyphoplasty. He had no trauma, chest pain, shortness of breath, or abnormal vital signs. Because of the unusual neck swelling and pain, he received IV hydromorphone and underwent CT imaging of the neck and chest, which revealed a cement embolus lodged at the bifurcation of the right main pulmonary artery.<br /><br />The patient remained hemodynamically stable and had no respiratory symptoms, so after discussion with neurosurgery, anticoagulation was not started. His pain improved with medication, and he was discharged home. Two days later, his oncologist reported complete resolution of the pain.<br /><br />The article explains that kyphoplasty and vertebroplasty are used to stabilize vertebral bodies and relieve pain, especially in patients with osteoporosis or malignancy. A known complication is leakage of bone cement, which can travel through venous channels to the lungs and cause pulmonary cement embolism. Although pulmonary embolism after these procedures may occur in up to 26% of patients, most cases are asymptomatic and do not require intervention. Treatment depends on symptoms and embolus location, and may include observation, anticoagulation, or surgery.<br /><br />The authors emphasize that pulmonary embolism can present atypically, including as referred neck, jaw, or shoulder pain. This case highlights the need for clinicians to consider cement embolism in patients with unexplained neck pain after kyphoplasty and to manage these cases collaboratively with neurosurgery and the patient.

Asset Subtitle

Dinesh Keerty

Meta Tag

Author List Dinesh Keerty, Hannah Shin, Kevin P. Eaton, Viktoriya Koverzhenko

Category Clinical Vignettes

Concept Pulmonary cement embolism

Concept Cement leakage

Concept Vertebral kyphoplasty

Concept Vertebroplasty

Concept Referred Pain

Distinguished Non-Finalist

Presenter Organization Moffitt Cancer Center

Presenting Author Dinesh Keerty

Track Adult

Keywords

kyphoplasty

pulmonary cement embolism

pancreatic cancer

neck pain

bone cement leakage

vertebroplasty

pulmonary artery

CT imaging

asymptomatic embolism

spinal procedure complication

Pulmonary cement embolism

Cement leakage

Vertebral kyphoplasty

Vertebroplasty

Referred Pain