Residual Thrombus within a Retrievable IVC Filter

Abstract

A 67-year-old woman underwent a laparotomy for presumed cholecystitis. A duodenal mass was discovered at the time of exploration. The abdomen was closed and the patient transferred to our institution. On arrival to our institution, she was noted to have shortness of breath and a computed tomographic (CT) examination of the chest revealed right lower lobe and right middle lobe pulmonary emboli. She was given heparin for anticoagulation. As the tumor appeared to be resectable, a pancreaticoduodenectomy (Whipple procedure) was planned. It was felt that performing this procedure on an anticoagulated patient was unwise, therefore a temporary inferior vena cava filter (Gunther Tulip filter, Cook, Bloomington, IN) was placed prior to surgery. Five days later, the patient underwent an uneventful pancreaticoduodenectomy. On postoperative day 5, the patient developed a fever and an intravenous contrast-enhanced abdominal CT was obtained (Fig 1). The CT showed thrombus entrapped within the appropriately positioned filter. On postoperative day 8, the referring physician requested removal of the filter, as it was felt that she was now a candidate for therapeutic anticoagulation. Prior to removing the filter, an inferior vena cavogram (Fig 2) was performed.