Asymptomatic Multiple Bilateral Segmental Pulmonary Embolisms Caused by Cement After Multilevel Vertebroplasty: A Case Report and Literature Review.

Pulmonary cement embolization (PCE) is a recognized, often asymptomatic complication of percutaneous vertebroplasty (PVP), a procedure commonly used to stabilize vertebral compression fractures. Here, we report the case of a 58-year-old male who, after vertebroplasty for multiple acute thoracic and lumbar fractures, exhibited segmental, peripheral PCE on postoperative imaging. Despite cement leakage into the pulmonary vasculature, the patient remained asymptomatic, stable, and was discharged following brief observation. A review of the literature reveals varied management approaches for asymptomatic PCE, from conservative monitoring to anticoagulation therapy, with outcomes generally favorable regardless of intervention. Our case supports the safety of conservative management in asymptomatic PCE, highlighting the need for standardized guidelines to aid clinical decision-making. Early detection through postoperative imaging, combined with tailored patient management, may improve outcomes while minimizing unnecessary interventions for asymptomatic PCE. Emergency physicians should be aware of PCE as a potential postoperative complication of vertebroplasty, even in asymptomatic patients, to ensure timely recognition, appropriate monitoring, and avoid unnecessary interventions.