{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:39:52Z","timestamp":1788280792039,"version":"build-2803163510"},"reference-count":15,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T00:00:00Z","timestamp":1757203200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Percutaneous vertebroplasty is an effective procedure for patients with osteoporosis and fractures. However, notable side effects may occur. Cement leakage into the vascular system may be incidental, with effects ranging from asymptomatic to life-threatening conditions. The treatment of extravasation of the cement and pulmonary embolism does not have definitive guidelines and requires specific treatment for every patient, ranging from basic anticoagulation to surgical procedures. Cement embolisms without periprocedural complications\u2014such as cardiac perforation or massive pulmonary embolism\u2014are often stable. However, symptomatic presentations with hemodynamic instability can occur. We report a clinically significant case of symptomatic cement pulmonary embolism resulting in shock. Case Presentation: A 68-year-old female patient with osteoporosis and a history of cement vertebroplasty two weeks prior to admission for vertebral compression fracture arrived with a three-day history of left leg swelling and shortness of breath. Vital signs revealed hypotension and the lab tests showed elevated lactate and D-dimer, mild leucocystosis, normal PCT and a threefold increase in CRP. The ultrasound confirmed complete thrombosis of the left external iliac and common femoral vein. The thoraco-abdominal CT demonstrated the extravasation of the cement from vertebroplasty to the inferior vena cava, lumbar veins, coupled with multiple cement structures in the segmental lobar pulmonary arteries. The echocardiography showed preserved right ventricular function. The management included intravenous fluids, anticoagulation and norepinephrine. Conclusions: This case underlines that cement pulmonary embolism following vertebroplasty, while typically undetected, can result in significant hemodynamic compromise even in the absence of right heart failure, potentially mediated by an inflammatory response. Importantly, it highlights the possibility of delayed clinical deterioration, with instability manifesting two weeks post-procedure\u2014distinct from the more commonly observed immediate peri-procedural complications or other stable delayed presentation.<\/jats:p>","DOI":"10.3390\/reports8030172","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T08:06:32Z","timestamp":1757318792000},"page":"172","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hemodynamic Instability from Cement Pulmonary Embolism Following Vertebroplasty: A Case Report"],"prefix":"10.3390","volume":"8","author":[{"given":"Bogdan","family":"Opri\u021b\u0103","sequence":"first","affiliation":[{"name":"Faculty of Medicine, \u201dCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Emergency Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgiana-Loredana","family":"Ghinea","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201dCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Emergency Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8597-9167","authenticated-orcid":false,"given":"Alexandru-Bogdan","family":"Dinu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201dCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Emergency Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruxandra","family":"Opri\u021b\u0103","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201dCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"636.e5","DOI":"10.1016\/j.ajem.2007.10.013","article-title":"Acute respiratory failure associated with polymethyl methacrylate pulmonary emboli after percutaneous vertebroplasty","volume":"26","author":"Zaccheo","year":"2008","journal-title":"Am. 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Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"A5196","DOI":"10.1016\/j.chest.2024.06.3090","article-title":"A Rare and Unforeseen Consequence: Cement Pulmonary Embolism Following Kyphoplasty","volume":"166","author":"Dinh","year":"2024","journal-title":"Chest"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"A6051","DOI":"10.1016\/j.chest.2023.07.3900","article-title":"A Case of Pulmonary Bone Cement Embolism: A Red Herring","volume":"164","author":"Nair","year":"2023","journal-title":"Chest"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Grover, T., Sajnani, S., Thippanna, R., and Chhabra, L. (2023). Bone Cement Pulmonary Embolism Following Vertebroplasty. J. Am. Coll. Cardiol., 81.","DOI":"10.1016\/S0735-1097(23)03571-4"},{"key":"ref_8","first-page":"e39194","article-title":"Pulmonary Cement Embolism After Vertebroplasty","volume":"15","author":"Malik","year":"2023","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Al-Husinat, L., Jouryyeh, B., Al Sharie, S., Al Modanat, Z., Jurieh, A., Al Hseinat, L., and Varrassi, G. (2023). Bone Cement and Its Anesthetic Complications: A Narrative Review. J. Clin. 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Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e41463","DOI":"10.1016\/j.heliyon.2024.e41463","article-title":"Successful retrieval of lower limbs artery bone cement embolization resulting from percutaneous vertebroplasty: A rare case report","volume":"11","author":"Shao","year":"2025","journal-title":"Heliyon"},{"key":"ref_15","first-page":"82","article-title":"Bone Cement Implantation Syndrome During Spinal Surgery Requiring Cardiac Surgery","volume":"1","author":"Sastre","year":"2013","journal-title":"AA Pract."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/3\/172\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:41:35Z","timestamp":1760035295000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/3\/172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,7]]},"references-count":15,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["reports8030172"],"URL":"https:\/\/doi.org\/10.3390\/reports8030172","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,7]]}}}