Embolization of Retrievable Inferior Vena Cava Filter Fragment to the Right Ventricle: A Case Report
Sandra Toth, Doran Mix, Scott Cameron, Brian Ayers, Roan Glocker, Jennifer Ellis, Adam Doyle, Kathleen Raman, Michael Stoner.
University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
A rare but life-threatening complication of indwelling IVC filters is filter fracture with intracardiac embolization of fragments that can compromise cardiac structures and cause sudden death. We present a unique case of IVC filter fracture with embolization to the right ventricle (RV) in a patient who remained clinically stable.
A 42-year-old female with a history of morbid obesity and hypertension presented to our clinic to discuss retrieval of an IVC filter. A retrievable filter was placed five years earlier for prophylaxis prior to gastric bypass. She noted chronic abdominal pain, which had been present for several years prior to filter placement, and a three-year history of vague chest pain and palpitations, which were felt to be unrelated to the filter components.
Review of an abdominal CT scan performed three years prior revealed a para-renal IVC filter in good position, but with a single arm missing. A lateral chest x-ray and chest CT revealed a linear hyperdense opacity embedded in the apex of the RV. Retrospective review of a chest CT performed three years prior demonstrated that the fragment had been in this same location at that time (Figure). An echocardiogram revealed normal cardiac without pericardial effusion. After consulting cardiothoracic surgery the decision was made to not pursue retrieval of the IVC filter main body or embolized fragment. She remains clinically stable on 6 month follow-up.
IVC filter fragmentation with intracardiac embolization is a rare phenomenon, with only 22 cases of RV embolization reported in the literature to date. The consequences of RV embolization are broad; some patients remain asymptomatic, while others experience cardiac tamponade and sudden death. Given the paucity of cases reported in the literature, the appropriate management of RV emboli remains undetermined.
We postulate that life-threatening consequences occur when a fragment ruptures the RV free wall, causing hemopericardium. In our patient's case, the fragment was embedded but had not penetrated the pericardial space, likely accounting for her asymptomatic presentation. We chose to manage our patient conservatively given the asymptomatic nature of her condition and the stable position of the fragment over a three-year interval.
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