title: Fatal pulmonary embolism: when the cause is not a thrombus.
abstract: METHODS
  We report a case of pulmonary embolism of polymethylmethacrylate material after percutaneous vertebroplasty.
  
  
  OBJECTIVE
  To describe a severe vertebroplasty complication, the pulmonary embolism, which proved to be fatal in a patient with many chronic disabilities.
  
  
  BACKGROUND
  Until 2007, the literature noted that the risk of embolism of polymethylmethacrylate after a percutaneous vertebroplasty counted a small number of pulmonary cement embolism and a smaller number of fatal consequences. The most recent research revealed that the risk of a pulmonary cement embolism ranges from 3.5% to 23% for osteoporotic compression fractures.
  
  
  METHODS
  This study is a case report of an 80-year-old patient with multiple medical comorbid factors, chronic obstructive pulmonary disease, mild renal failure, osteoporosis, and hepatic cirrhosis. Symptoms of pulmonary embolism developed 1 month after a percutaneous vertebroplasty. An echocardiography report suggested that the cement infiltrated the right atrium and the right pulmonary artery, and this was confirmed by a computed tomographic scan. As the therapy with oxygen and low-molecular-weight heparin failed to solve the thrombus, the patient required a surgical tricuspid annuloplasty and the extirpation of the right atrial and right pulmonary masses.
  
  
  RESULTS
  The course of the operation was complicated by pulmonary infection, and the patient ultimately succumbed to infection/respiratory failure.
  
  
  CONCLUSIONS
  The presence of intravascular/intracardiac foreign bodies is underreported in literature, but it is quite common in clinical practice. We need to discuss the choice of some non-risk-free interventions such as vertebroplasty in older patients already affected by multiple main disabilities.
authors.affiliation: Cardiology Division, Internal Medicine Department, Ospedale Civico di Chivasso (Turin), Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Franco
authors.forename: Simone
authors.initials: S
authors.lastname: Frea
authors.forename: Cristina
authors.initials: C
authors.lastname: Solaro
authors.forename: Valentina
authors.initials: V
authors.lastname: Conti
authors.forename: Francesco
authors.initials: F
authors.lastname: Pinneri
mesh_terms: D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000209:etiology*; D054854:Vertebroplasty / Q000009:adverse effects*
chemical_list: D001843:Bone Cements