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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 2723639710.5144/0256-4947.2016.232asm-3-232ImagesPulmonary arterial cement embolization: a rare complication of vertebroplasty Ajlan Amr Mohammad From the Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi ArabiaCorrespondence: Dr. Amr Mohammad Hassan Abdulrazaq Ajlan, Department of Radiology, King Abdulaziz University, Jeddah, 21411, Saudi Arabia, T: 022-6408222 Ext. 18163, amrajlan@yahoo.com, ORCID ID: http://orcid.org/0000-0001-8199-1915May-Jun 2016 36 3 232 233 Copyright © 2016, Annals of Saudi Medicine2016This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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A 73-year-old male presented with slowly progressive dyspnea and no other complaints. The clinical examination was unremarkable, apart from lumber spine orthopedic fixation and vertebroplasty procedure that were performed 7 months prior to this presentation. The posteroanterior and lateral chest radiographs revealed high-density tubular and branching structures, radiating from the hila (arrows in Figures 1 and 2). A maximum intensity projection computed tomography image confirmed that the dense abnormalities are related to the pulmonary arteries (arrows in Figure 3). A lateral lumber spine radiograph confirmed the presence of orthopedic fixation hardware and vertebroplasty (arrow in Figure 4), along with cement embolization into adjacent lumbar veins (arrowhead in Figure 4). This example highlights a rare complication of the vertebroplasty procedure in the form of non-thrombotic pulmonary arterial cement emboli. Cardiopulmonary manifestations of cement embolization may be treated conservatively, with anticoagulation or by partial surgical lung resection.1 The patient was treated conservatively and persisted to have mild non-limiting dyspnea.

Figure 1 Posteroanterior chest radiograph showing high-density tubular and branching structures that radiate from the hila (arrows).

Figure 2 Lateral chest radiograph showing the same high-density tubular and branching material (arrows).

Figure 3 Maximum intensity projection computed tomography image confirms the presence of high-density material within the pulmonary arteries (arrows).

Figure 4 Lumber spine radiograph showing orthopedic fixation hardware and vertebroplasty (arrow), along with cement embolization into lumbar veins (arrowhead).
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REFERENCE
1 Rothermich MA  Buchowski JM  Bumpass DB  Patterson GA   Pulmonary cement embolization after vertebroplasty requiring pulmonary wedge resection Clinical orthopaedics and related research 2014 472 1652 1657 24532433