Migration of Fragment of Inferior Vena Cava Filter to Pulmonary Artery

Abstract

SESSION TITLE: Imaging SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Inferior Vena Cava (IVC) filters are recommended for prevention of pulmonary embolism in patients who have deep vein thrombosis (DVT) with contraindication to anticoagulation. IVC filters are either retrievable or non-retrievable. Retrievable filters are commonly used and they should be removed within 30 days of placement. Migration of fragments of IVC filter is a rare complication of this procedure (incidence <1%). In literature, fragments have been noted to migrate mainly to the right side of the heart or the pulmonary arteries. CASE PRESENTATION: A 72 y/o male with history of COPD came to emergency room for shortness of breath. Patient had an IVC filter placed two and a half years earlier after an episode of lower extremity DVT. He was a past smoker who quit many years back.Chest radiograph on admission showed findings suspicious for foreign body in a branch of right pulmonary artery. Computerized tomography of chest was done which revealed a thin linear metallic density in one of the sub-segmental branches of right lower lobe pulmonary artery, possibly a fractured piece of IVC filter. On retrospective review of chest radiographs, this metallic foreign body was visible after six months from the placement of the IVC filter. Patient did not recall having any other procedures or catheter placement except the IVC filter placement. Cardiothoracic surgery decision was not to intervene in this patient as this was an incidental finding without squeal. DISCUSSION: Management of an IVC filter fragment that migrates into pulmonary artery can be challenging. A variety of treatment options ranging from conservative management to endovascular or open surgical extraction of the migrated struts have been suggested. There are no clear guidelines nor sufficient literature on how to best manage and treat such complex situations. General consensus is to intervene in patients with complications like perforation of pulmonary artery. This case illustrates the importance of removal of IVC filters following the guideline and as soon as it is no longer needed. CONCLUSIONS: This case illustrates the need for clinicians to be aware to remove IVC filters when its no longer needed otherwise it could lead to disastrous complications. Reference #1: Tamer Hudali, Ali Zayed et al. A fractured inferior vena cava filter strut migrating to the left pulmonary artery. Respir Med Case Rep. 2015;16:3-6 Reference #2: Nicholas A. Rogers et al. Fracture and Embolization of an Inferior Vena Cava Filter Strut Leading to Cardiac Tamponade. Circulation. 2009;119:2535-2536. DISCLOSURE: The following authors have nothing to disclose: Praneet Iyer, Rabin Shrestha, Marwan Odeesh, Anurag Mehrotra, Muhammad Zaman No Product/Research Disclosure Information