There is no consensus on treatment for this condition. One group proposed an algorithm for treatment options based on location and symptomatology (see Figure 2).2 If a patient is asymptomatic with a central clot or symptomatic with a peripheral clot, anticoagulation is recommended. Patients who are symptomatic with a central clot should have surgical removal considered. Finally, asymptomatic patients with peripheral emboli can be safely monitored. Others suggest endovascular removal of the emboli to prevent further migration of central clots and symptomatic peripheral ones.3 Based on one in vitro study, it does not appear that PMMA facilitates platelet aggravation or clot formation.4 Overall the prognosis for pulmonary cement embolism appears to be good, and in the literature, there are only six associated mortalities reported.1
Dr. Adams is a third-year resident and Dr. Effron is an attending physician in the department of emergency medicine at MetroHealth Medical Center and Case Western Reserve University in Cleveland.
- Rodrigues DM, Cunha Machado DP, Campainha Fernandes SA, et al. Pulmonary cement embolism following balloon kyphoplasty: the impact of a procedural complication in a new era for lung cancer management. Mol Clin Oncol. 2019;10(2):299-303.
- Krueger A, Bliemel C, Zettl R, et al. Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature. Eur Spine J. 2009;18(9):1257-1265.
- Rothermich MA, Buchowski JM, Bumpass DB, et al. Pulmonary cement embolization after vertebroplasty requiring pulmonary wedge resection. Clin Orthop Relat Res. 2014;472(5):1652-1657.
- Blinc A, Bozic M, Vengust R, et al. Methyl-methacrylate bone cement surface does not promote platelet aggregation or plasma coagulation in vitro. Thromb Res. 2004;114(3):179-184.