Intracardiac, pulmonary cement embolism in a 67-year-old female after cement-augmented pedicle screw instrumentation: A case report and review of literature

Figure 1 Internal fixation of a 67-year-old patient with osteoporotic bone. A: Preoperative (March 15, 2017) lumbar spine plain radiograph lateral view; B: Anteroposterior view; C: Postoperative lumbar spine plain radiograph lateral view at 3 d (March 25, 2017); D: Anteroposterior view showing the leakage of bone cement through the venous system (high-density line indicated by the orange arrow) and the extent of cement augmentation of the lumbar spine.

Figure 2 Bone cement entering the vascular system. A-C: Postoperative computerized tomography scan showing the bone cement emboli in the pulmonary, cardiac, and venous system at 6 d (March 30, 2017). Cement is indicated by the orange arrow; and D: Three-dimensional reconstruction of the thoracic showing the distribution of the emboli.

Figure 3 Radiography examination after indicated time of embolization. A: Preoperative chest radiography at 2 d; B: Postoperative chest radiography at 12 mo (March, 2018); C: Postoperative chest radiography at 24 mo (March, 2019); D: Postoperative computerized tomography scan at 30 mo (September, 2019).

Figure 4 Timeline flow diagram of the case. CT: Computerized tomography; LMWH: Low molecular weight heparin.