Bone cement‐induced pulmonary embolism in a myeloma patient

A 62-year-old woman was diagnosed with IgG-kappa multiple myeloma, stage III according to the Durie-Salmon staging system (haemoglobin concentration, 78 g/l; multiple bone lesions). Percutaneous vertebroplasty from the 12th thoracic to the 3rd lumbar segments was carried out for relief of intolerable low back pain associated with vertebral compression. However, she experienced sudden onset of dyspnoea after this treatment. An echocardiogram revealed dilation of the right ventricular chamber with tricuspid valve regurgitation and an increased peak systolic pressure gradient (41·7 mmHg), suggesting pulmonary hypertension. Chest radiography showed opacified lesions over the right pulmonary artery (left, arrows); this finding was suggestive of bone cement-induced pulmonary embolism. Computed tomography angiography showed high-density lesions in the inferior vena cava (right, arrows) and both pulmonary arteries (right, arrowheads), further confirming this diagnosis. Pulmonary thrombectomy by cardiac catheterization was carried out because of worsening pulmonary distress, despite oxygen supplementation and administration of anticoagulants. Unfortunately, the bone cement was fragile and only one piece of bone cement measuring 15 mm could be extracted. The patient eventually died of cardiopulmonary failure resulting from pulmonary embolism. Although vertebroplasty can effectively relieve bone pain associated with vertebral compression fractures, bone cement-induced pulmonary embolism can be a rare but fatal complication. Pulmonary thrombectomy may not be an effective treatment for bone cement-induced pulmonary embolism, and more attention should be focused on patients who experience dyspnoea after percutaneous vertebroplasty.