Browse ATS 2021 Abstracts

HomeProgram ▶ Browse ATS 2021 Abstracts

ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Embolization of Surgical Cement to the Pulmonary Arteries, Is There a Reason to Worry?

Session Title
A3525 - Embolization of Surgical Cement to the Pulmonary Arteries, Is There a Reason to Worry?
Author Block: A. Beckman1, T. Ho1, J. Scott2, M. Darnell2, P. Rali3, M. Vega Sanchez3; 1Internal Medicine, Temple University Hospital, Philadelphia, PA, United States, 2Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, PA, United States, 3Lewis Katz School of Medicine, Philadelphia, PA, United States.
Embolization of surgical cement to the pulmonary arteries is a rare complication of spinal repair surgery. The infrequency of this complication poses a dilemma regarding management. A 51-year-old female with metastatic renal cell carcinoma presented to the emergency department for acute on chronic lumbar back pain. Her metastasis involved the lumbar spine and she had undergone radiotherapy in addition to biologic and immunotherapy. On physical exam, she had 4/5 bilateral lower extremity strength but no other objective neurological deficits. MRI of the lumbar spine revealed a pathological compression fracture at L1 with retropulsion causing canal stenosis and spinal cord compression. She was admitted to neurosurgery and underwent urgent posterior decompression, a T12-L2 laminectomy and right facetectomy, T11-L3 fusion, and L4 kyphoplasty and vertebroplasty. Her immediate post-operative period was uncomplicated, except for mild hypotension. She was started on deep vein thrombosis (DVT) prophylaxis with mechanical compression devices and daily enoxaparin injections. On POD 5, she became acutely short of breath, febrile to 100.6 F, tachycardic to 115 bpm, hypotensive to 94/60 and oxygen saturation of 95% on 2 liters nasal canula. On physical exam, her right lower extremity appeared larger than the left and she was found to have a posterior tibial vein DVT by ultrasonography. A computed tomography (CT) angiogram of the thorax showed multiple linear foci of hyperdense material within several pulmonary arteries consistent with embolized cement material. The patient was started on systemic anticoagulation and she had no further symptoms or hemodynamic compromise. The discharge plan from the Pulmonary-Embolism Response Team was to continue anticoagulation with therapeutic dose enoxaparin and obtain a follow up ventilation-perfusion scan to monitor the cement emboli. Prior to discharge, the patient became acutely lethargic with anisocoria and right facial weakness. CT head revealed edema and mass effect from new and old areas of metastatic disease. Her mental status continued to deteriorate and she ultimately passed on comfort-directed care. This case demonstrates cement emboli as an alarming post-operative finding though its clinical significance was small. Review of other cases suggests the populations most at risk for cement embolization to be those with pathological spine fractures due to existing metastatic disease. It appears that no additional interventions beyond anticoagulation are necessary and that outcomes are related more to their predisposing condition for the spinal fracture.