Acute massive pulmonary thromboembolism caused by cord-like foreign bodies in the heart and pulmonary arteries after percutaneous vertebroplasty: a case report and literature review.

BACKGROUND: Bone cement leakage is a complication of percutaneous vertebroplasty. However, the cement can extremely rarely extravasate into the heart and pulmonary arteries and form cord-like foreign bodies, inducing acute massive pulmonary thromboembolism.

CASE PRESENTATION: We present a case of a patient who developed acute massive pulmonary thromboembolism within 2 weeks after PVP, resulting from bone cement leakage into the heart and pulmonary arteries with subsequent thrombosis. Lower extremity vascular ultrasonography ruled out the possibility of thrombus detachment secondary to deep venous thrombosis. Computed tomography pulmonary angiography revealed strip-shaped hypodense filling defects in the main trunks and some branch arteries of the bilateral pulmonary arteries and a cord-like hyperdense shadow. Combined computed tomography pulmonary angiography and three-dimensional reconstruction of the thoracic spine showed that the cord-like foreign body originated from the 8th thoracic vertebra, entered the azygos vein through the vertebral venous system, then continuously traversed the superior vena cava and right cardiac system, and finally extended to the main trunk of the right pulmonary artery, as well as the branches of both pulmonary arteries. Following aggressive surgical thrombolysis and postoperative anticoagulant therapy, the patient's symptoms immediately improved. Nevertheless, computed tomography pulmonary angiography still showed the cord-like foreign body after 3 months.

CONCLUSION: Moreover, this report retrospectively analyzes the diagnostic and therapeutic strategies for pulmonary thromboembolism secondary to bone cement leakage after percutaneous vertebroplasty through a literature review.