[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-417172-105":59,"doc-detail-417172-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","not-all-emboli-are-thrombotic-the-silent-cement-to-the-lungs-letter-to-the-editor","Not All Emboli are Thrombotic: The Silent Cement to the Lungs - Letter to the Editor","","The letter highlights that pulmonary cement embolism (PCE) is an underrecognized iatrogenic cause of postoperative pulmonary complications. It explains that PCE may follow vertebroplasty or kyphoplasty when small polymethylmethacrylate cement fragments enter the venous system and migrate to the lungs. Although often asymptomatic, PCE can be detected on imaging and may present later with respiratory symptoms or hemodynamic collapse, requiring heightened clinical vigilance. Management varies by clinical status and embolus burden, with prevention supported by careful cement injection and advanced imaging.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/not-all-emboli-are-thrombotic-the-silent-cement-to-the-lungs-letter-to-the-editor/417172/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/not-all-emboli-are-thrombotic-the-silent-cement-to-the-lungs-letter-to-the-editor/417172.png","ImageObject",300,407,{"name":92,"@type":93},"RuangKosong","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is pulmonary cement embolism (PCE) and when can it occur?","Question",{"text":112,"@type":113},"PCE is an iatrogenic embolic condition that can occur after vertebroplasty or kyphoplasty when cement fragments leak into the venous system and migrate to the lungs.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why is PCE often missed in postoperative pulmonary complication assessments?",{"text":117,"@type":113},"PCE is frequently underdiagnosed because it is not routinely considered among vascular complications, despite being identifiable with chest imaging.",{"name":119,"@type":110,"acceptedAnswer":120},"How is PCE typically managed and what prevention measures are suggested?",{"text":121,"@type":113},"Management depends on clinical status and embolus burden, ranging from observation to anticoagulation and rarely surgery. Prevention includes using high-viscosity cement and careful injection under fluoroscopy.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},417172,1792768364,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":81,"preview_page_count":4},962090883219,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Letter to the Editor  56  \nContent of this journal is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.  \nBalkan Med J 2026;43:56  \nNot All Emboli are Thrombotic: The Silent Cement to the Lungs  \n Çağlar Kaya  \nDepartment of Cardiology, Trakya University Faculty of Medicine, Edirne, Türkiye  \nI read with great interest the article by Ufuk et al.1 titled,“Postoperative Pulmonary Complications: Clinical and Imaging Insights”. Thereview provides a detailed overview of postoperative pulmonary complications and emphasizes the key role of imaging. However, one important entity, that is, pulmonary cement embolism (PCE), was not mentioned among the vascular complications.  \nPCE, an iatrogenic embolic condition that can occur after vertebroplasty or kyphoplasty, must be included in future discussions about postoperative pulmonary complications. PCE occurs when small bone cement fragments (polymethylmethacrylate) leak into the venous system during spinal procedures and migrate to the lungs through the azygos and the caval veins.2 Most cases areasymptomatic and discovered incidentally during chest imaging; however, severe cases can cause shortness of breath, chest pain, or hemodynamic collapse. Although the symptom incidence is low (0 .1-0. 5%), studies using computed tomography (CT) have reported imaging-detected rates ranging from 2% to 26% .3 With the increasing usage of vertebroplasty in elderly patients, awareness of this complication is becoming increasingly important. According to several case reports in the literature, patients develop PCE months or even years after vertebroplasty.2 Chest radiographs in these reports often reveal linear or nodular high-density opacities. At the same time, CT pulmonary angiography demonstrates radiopaque cement fragments within the pulmonary arteries and, sometimes, within the right cardiac chambers. Most patients were treated conservatively or with anticoagulation therapy, thereby showing clinical improvement. The obtained findings emphasize that PCE can remain clinically silent for extended periods and present either in the early postoperative phase or several years later. Therefore, clinicians must remain vigilant for PCE when encountering unexplained radiopaque intravascular lesions or persistent respiratory symptoms after spinal cement procedures. Recent studies confirmed that PCE is frequently underdiagnosed because it is not routinely considered.4 Most patients remain stable; however, large or centrally located cement fragments can cause respiratory distress, arrhythmia, or cardiac tamponade.3-5 PCE management generally depends on the patient’s clinical status and embolus burden, ranging from a simple  \nobservation in stable cases to anticoagulation or, rarely, to surgical intervention in severe or symptomatic presentations.5 Preventive measures, including the usage of high-viscosity cement and careful injection under fluoroscopy, are crucial in risk reduction.3 Accordingly, better awareness and timely recognition supported by advanced imaging approaches, such as three-dimensional echocardiography in pulmonary vascular assessment, may help improve patient care and safety.6 Although postoperative pulmonary complications are among the most concerning adverse events following surgery, clinicians must also be aware that severe cardiovascular complications, such as acute stent thrombosis or acute heart failure, can also develop after surgery.7  \nIn conclusion, PCE isan uncommon but clinically crucial postoperative complication that can mimic thromboembolic disease and lead toa delayed or missed diagnosis. That is to say, early recognition and individualized management can improve patient outcomes and safety.  \nREFERENCES  \n1. Ufuk F, Ocak İ, Chelala L, Landeras L. Postoperative pulmonary complications: clinical and imaging insights. Balkan MedJ. 2025;42:405-418 . [CrossRef]  \n2. Bulburu İB, Kaya Ç, Ustabaşıoğlu FE. A Journey from vertebra to pul","cbCaievyw5gkFHuJ","https://ap.wps.com/l/cbCaievyw5gkFHuJ","pdf",75720,"English","# Not All Emboli are Thrombotic: The Silent Cement to the Lungs\n## Letter to the Editor\n## Key points on PCE and imaging\n## Clinical presentation and incidence\n## Diagnosis, management, and prevention","[{\"question\":\"What is pulmonary cement embolism (PCE) and when can it occur?\",\"answer\":\"PCE is an iatrogenic embolic condition that can occur after vertebroplasty or kyphoplasty when cement fragments leak into the venous system and migrate to the lungs.\"},{\"question\":\"Why is PCE often missed in postoperative pulmonary complication assessments?\",\"answer\":\"PCE is frequently underdiagnosed because it is not routinely considered among vascular complications, despite being identifiable with chest imaging.\"},{\"question\":\"How is PCE typically managed and what prevention measures are suggested?\",\"answer\":\"Management depends on clinical status and embolus burden, ranging from observation to anticoagulation and rarely surgery. Prevention includes using high-viscosity cement and careful injection under fluoroscopy.\"}]","Not All Emboli are Thrombotic: The Silent Cement to the Lungs - Letter to the Editor | PDF",1790608327]