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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 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2009 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/119/18/2535 Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/ Downloaded from http://circ.ahajournals.org/ by guest on June 17, 2014 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 Downloaded from http://circ.ahajournals.org/ by guest on June 17, 2014 2536 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. Downloaded from http://circ.ahajournals.org/ by guest on June 17, 2014