Polymethyl methacrylate is an orthopedic cement which hardens from a liquid to a solid as it polymerizes. Leakage of the cement into the venous system during surgery can result in pulmonary emboli.


Clinical features:

(1) orthopedic surgery using orthopedic cement (kyphoplasty, vertebroplasty, other)

(2) venous cement leakage

(3) high pressure applied to the cement

(4) chest X-ray show one or more dense opacities that may be:

(4a) small and diffuse

(4b) tubular and branching


The exact frequency is unknown since many cases are asymptomatic and few patients have appropriate imaging studies.


If symptoms do develop they may range from minor to catastrophic. Symptoms may include chest pain, dyspnea, hemoptysis and respiratory failure.


The initial diagnosis is usually a fibrin-platelet pulmonary embolus. It is important to recognize a cement embolus since thrombolytic therapy would be useless.


In an asymptomatic patient with a few emboli no therapy is required. Embolectomy may be required for a large embolus.


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