Pulmonary cement embolism following balloon kyphoplasty: The impact of a procedural complication in a new era for lung cancer management

Abstract

Pulmonary cement embolism (PCE) is a recognized complication of balloon kyphoplasty, a vertebral augmentation technique that stabilizes vertebral compression fractures, alleviating associated pain. Balloon kyphoplasty is particularly relevant when patients with advanced stages of cancer present with longer survival times, and therefore benefit from such augmentation techniques to improve pain and prevent additional complications. The embolization of cement to pulmonary vasculature may be unnoticed given the frequent absence of symptoms and routine imaging tests following the procedure. The present study reports the case of a 58-year-old female with stage IV lung cancer with a painful compression L3 fracture who underwent balloon kyphoplasty with no initially reported complications. The patient maintained the usual respiratory symptoms; therefore, the diagnosis was only made in a routine CT scan 3 months after the surgery. A literature review of PCE is performed, integrating the current evidence regarding diagnosis, therapeutics, prognosis and prevention. Certain poorly clarified aspects are identified as potential investigation starting points.