Download Fracture and Embolization of an Inferior Vena Cava Filter Strut

Fracture and Embolization of an Inferior Vena Cava Filter Strut Leading to Cardiac
Tamponade
Nicholas A. Rogers, Lynn Nguyen, Nicole E. Minniefield, Michael E. Jessen and James A. de
Lemos
Circulation. 2009;119:2535-2536
doi: 10.1161/CIRCULATIONAHA.108.817247
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Images in Cardiovascular Medicine
Fracture and Embolization of an Inferior Vena Cava Filter
Strut Leading to Cardiac Tamponade
Nicholas A. Rogers, MD; Lynn Nguyen, MD; Nicole E. Minniefield, MD;
Michael E. Jessen, MD; James A. de Lemos, MD
A
56-year-old woman presented to the Emergency Department of Parkland Memorial Hospital complaining of
chest pain. She had a remote history of a hemorrhagic
cerebrovascular accident complicated by pulmonary embolism, for which a Gunther-Tulip inferior vena cava (IVC)
filter had been placed 6 years previously. In the triage area,
the patient collapsed and was found to be hypotensive. An
ECG showed sinus bradycardia with nonspecific ST and
T-wave changes (Figure 1). Bedside echocardiography demonstrated a moderate-sized pericardial effusion with evidence
of cardiac tamponade. A pericardiocentesis was performed
with removal of 25 mL of blood, and the patient’s vital signs
stabilized. A portable chest x-ray suggested a foreign body
just above the left hemidiaphragm (Figure 2), which was
confirmed by computed tomographic (CT) scan of the chest,
which revealed a linear metallic foreign body in the left
anterior pericardium adjacent to the right ventricle (Figure 3).
On the abdominal CT scan, one of the struts from the
patient’s IVC filter was not visualized with the remainder of
the IVC filter (Figure 4). The patient was taken to the
operating room, where exploration of the pericardial space
demonstrated a small laceration of the right ventricular free
wall (Figure 5) and a linear 3-cm metallic foreign body
(Figure 6) consistent with the missing IVC filter strut. The
patient recovered uneventfully from surgery. IVC strut fracture occurs in fewer than 5% of cases,1,2 and embolization has
been reported as a rare complication of strut fracture.3
Disclosures
None.
References
1. Kalva SP, Chlapoutaki C, Wicky S, Greenfield AJ, Waltman AC, Athanasoulis CA. Suprarenal inferior vena cava filters: a 20-year single-center
experience. J Vasc Interv Radiol. 2008;19:1041–1047.
2. Ferris EJ, McCowan TC, Carver DK, McFarland DR. Percutaneous
inferior vena caval filters: follow-up of seven designs in 320 patients.
Radiology. 1993;188:851– 856.
3. Ganguli S, Tham JC, Komlos F, Rabkin DJ. Fracture and migration of a
suprarenal inferior vena cava filter in a pregnant patient. J Vasc Interv
Radiol. 2006;17:1707–1711.
Figure 1. ECG performed in the emergency room
showing sinus bradycardia and nonspecific ST and
T-wave abnormalities.
From the Departments of Internal Medicine (N.A.R., L.N., N.E.M., J.A.d.L.) and Cardiovascular and Thoracic Surgery (M.E.J.), University of Texas
Southwestern Medical Center, Dallas.
Correspondence to James A. de Lemos, MD, University of Texas Southwestern Medical Center, 5909 Harry Hines Blvd, HA 9.133, Dallas, TX
75390-9047. E-mail [email protected]
(Circulation. 2009;119:2535-2536.)
© 2009 American Heart Association, Inc.
Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.108.817247
2535
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Circulation
May 12, 2009
Figure 2. Chest x-ray showing a linear foreign body in the left
thorax just above the left hemidiaphragm.
Figure 5. Intraoperative photograph highlighting the puncture of
the right ventricular free wall.
Figure 6. Photograph of the fractured stent strut that was
recovered during surgery.
Figure 3. Chest CT scan with arrow delineating a linear foreign
body in the left anterior pericardial space.
Figure 4. Abdominal CT scan demonstrating the Gunther-Tulip
IVC filter. The arrow points to the area of the missing filter strut.
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