{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T12:00:30Z","timestamp":1777636830446,"version":"3.51.4"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>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\u2019s symptoms immediately improved. Nevertheless, computed tomography pulmonary angiography still showed the cord-like foreign body after 3 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1801254","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T05:54:53Z","timestamp":1777442093000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3389","volume":"13","author":[{"given":"Fukang","family":"Zou","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, The Second Affiliated Hospital of Naval Medical University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanyuan","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Second Affiliated Hospital of Naval Medical University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lefeng","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, The Second Affiliated Hospital of Naval Medical University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianjin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, The Second Affiliated Hospital of Naval Medical University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"202","DOI":"10.3390\/jpm13020202","article-title":"Nontrombotic pulmonary embolism: different etiology, same significant consequences.","volume":"13","author":"Sirbu","year":"2023","journal-title":"J Pers Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e24542","DOI":"10.1016\/j.heliyon.2024.e24542","article-title":"Pulmonary embolism and hemorrhage after displacement of angiographic catheter tip to pulmonary artery: a case report and literature review.","volume":"10","author":"Xiong","year":"2024","journal-title":"Heliyon."},{"key":"B3","doi-asserted-by":"publisher","first-page":"505","DOI":"10.2214\/ajr.16.17326","article-title":"Nonthrombotic pulmonary artery embolism: imaging findings and review of the literature.","volume":"208","author":"Unal","year":"2017","journal-title":"Am J Roentgenol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e49","DOI":"10.1056\/nejmicm2032931","article-title":"Intracardiac cement embolism.","volume":"385","author":"Weininger","year":"2021","journal-title":"N Engl J Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1056\/NEJMicm1010341","article-title":"Images in clinical medicine. Pulmonary cement embolism after vertebroplasty.","volume":"366","author":"Tourtier","year":"2012","journal-title":"N Engl J Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1016\/S0140-6736(10)60954-3","article-title":"Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial.","volume":"376","author":"Klazen","year":"2010","journal-title":"Lancet."},{"key":"B7","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1007\/s00330-018-5647-0","article-title":"Intracardiac cement embolism during percutaneous vertebroplasty: incidence, risk factors and clinical management.","volume":"29","author":"Fadili Hassani","year":"2019","journal-title":"Eur Radiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1186\/s12891-022-05469-5","article-title":"The mechanism by which enoxaparin sodium-high-viscosity bone cement reduces thrombosis by regulating CD40 expression in endothelial cells.","volume":"23","author":"Sang","year":"2022","journal-title":"BMC Musculoskelet Disord."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e977","DOI":"10.1016\/j.jacc.2025.11.005","article-title":"2026 AHA\/ACC\/ACCP\/ACEP\/CHEST\/SCAI\/SHM\/SIR\/SVM\/SVN guideline for the evaluation and management of acute pulmonary embolism in adults: a report of the American college of cardiology\/American heart association joint committee on clinical practice guidelines.","volume":"153","author":"Creager","year":"2026","journal-title":"J Am Coll Cardiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1001\/jama.2020.3905","article-title":"Management of acute pulmonary embolism.","volume":"324","author":"Paul","year":"2020","journal-title":"JAMA."},{"key":"B11","doi-asserted-by":"publisher","first-page":"10760296231198036","DOI":"10.1177\/10760296231198036","article-title":"The bone cement hypercoagulation syndrome: pathophysiology, mortality, and prevention.","volume":"29","author":"Dahl","year":"2023","journal-title":"Clin Appl Thromb."},{"key":"B12","doi-asserted-by":"publisher","first-page":"3962","DOI":"10.1097\/JS9.0000000000003736","article-title":"Effect of low-temperature modulation of bone cement viscosity on the efficacy of cement dispersion and clinical outcomes after percutaneous Kyphoplasty: a retrospective cohort study.","volume":"112","author":"Zhang","year":"2025","journal-title":"Int J Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1016\/j.spinee.2021.12.013","article-title":"High viscosity bone cement vertebroplasty versus low viscosity bone cement vertebroplasty in the treatment of mid-high thoracic vertebral compression fractures.","volume":"22","author":"Luo","year":"2022","journal-title":"Spine J Off J North Am Spine Soc."},{"key":"B14","doi-asserted-by":"publisher","first-page":"3000605211046115","DOI":"10.1177\/03000605211046115","article-title":"Cement-associated thrombotic embolism in the inferior vena cava and bilateral iliac veins after percutaneous vertebroplasty: a case report.","volume":"49","author":"Hu","year":"2021","journal-title":"J Int Med Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"106632","DOI":"10.1016\/j.ijsu.2022.106632","article-title":"Risk factors for pulmonary cement embolism associated with percutaneous vertebral augmentation: a systematic review and meta-analysis.","volume":"101","author":"Sun","year":"2022","journal-title":"Int J Surg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1129658","DOI":"10.3389\/fonc.2023.1129658","article-title":"Risk factors for pulmonary cement embolism after percutaneous vertebroplasty and radiofrequency ablation for spinal metastases.","volume":"13","author":"Wang","year":"2023","journal-title":"Front Oncol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e45","DOI":"10.1016\/j.jemermed.2020.10.045","article-title":"Delayed symptomatic pulmonary embolism secondary to bone cement after percutaneous vertebroplasty.","volume":"60","author":"Drigalla","year":"2021","journal-title":"J Emerg Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1093\/eurheartj\/ehac588","article-title":"Pulmonary artery bone cement embolization resulting from percutaneous vertebroplasty.","volume":"44","author":"Ku","year":"2023","journal-title":"Eur Heart J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/j.spinee.2014.10.029","article-title":"Cardiopulmonary cement embolism after vertebroplasty.","volume":"15","author":"Polli","year":"2015","journal-title":"Spine J Off J North Am Spine Soc."},{"key":"B20","doi-asserted-by":"publisher","first-page":"2011","DOI":"10.1016\/j.asjsur.2022.10.104","article-title":"Acute pulmonary embolism associated with bone cement: a case report and literature review.","volume":"46","author":"Xu","year":"2023","journal-title":"Asian J Surg."},{"key":"B21","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1097\/RLU.0000000000003423","article-title":"Resolution of pulmonary cement embolism after treatment of rivaroxaban on ventilation\/perfusion SPECT image.","volume":"46","author":"Kim","year":"2021","journal-title":"Clin Nucl Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1221525","DOI":"10.3389\/fcvm.2023.1221525","article-title":"Case report: open-heart removal for a cement embolism formed 10 years ago in the right ventricle and pulmonary artery.","volume":"10","author":"Liu","year":"2023","journal-title":"Front Cardiovasc Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"030006052211020","DOI":"10.1177\/03000605221102088","article-title":"Life-threatening intracardiac cement embolisms after percutaneous kyphoplasty: a case report and literature review.","volume":"50","author":"Huang","year":"2022","journal-title":"J Int Med Res."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1801254\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T05:54:54Z","timestamp":1777442094000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1801254\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":23,"alternative-id":["10.3389\/fmed.2026.1801254"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1801254","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]},"article-number":"1801254"}}