Inferior Vena Cava Filter Limb Fracture with Embolization to the Right Ventricle

Publication date: Available online 6 March 2017
Source:The Journal of Emergency Medicine
Author(s): Bradley S. Jackson, Mykel Sepula, Jared T. Marx, Chad M. Cannon
BackgroundInferior vena cava (IVC) filter and filter limb embolization is a known phenomenon, with a prevalence of up to 25% for certain filter types. Most commonly, the site of embolization is to the heart. Point-of-care ultrasound is an easily accessible imaging modality that should be utilized when considering IVC filter complications.Case ReportA 28-year-old woman with a history of metastatic sarcoma and IVC filter placement for deep venous thrombosis presented to the Emergency Department (ED) for chest pain. Chest radiography was reviewed and originally thought to have no abnormalities. Chest computed tomography angiography was negative for filling defects or foreign bodies. A possible foreign body in the heart was noted by a radiologist's over-read of the original chest radiograph. An echocardiogram done by Cardiology was negative for foreign bodies or other abnormalities. Next, an emergency physician performed a bedside echocardiogram, with focused attention to the right side of the heart. An echogenic foreign body was visualized in the right ventricle. The patient was subsequently taken to the cardiac catheterization laboratory, where fluoroscopic visualization of a limb wire of an IVC filter within the right ventricle was obtained. That foreign body was subsequently removed successfully, along with removal of the broken IVC filter.Why Should an Emergency Physician Be Aware of This?This case report highlights the utility of point-of-care ultrasound in the work-up of a patient with an embolized IVC filter wire. Chest pain patients frequently receive point-of-care echocardiography in the ED, and these ultrasound findings should be recognized and used to guide further treatment and consultation.



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