SESSION TITLE: Dyspena MysteriesSESSION TYPE: Rapid Fire Case ReportsPRESENTED ON: 10/18/2022 01:35 pm - 02:35 pmINTRODUCTION: The chance of a mechanical failure for an IVC filter is directly proportional to its dwell time within the patient. In this case report we will discuss a rare and potentially fatal complication caused by forgotten filters.CASE PRESENTATION: A 60-year-old man presents to the emergency room after experiencing 4 days of chest pain and shortness of breath that progressively worsened after shoveling snow. Patient's past medical history is significant for tobacco use, GERD and a MVA 16 years prior that resulted in a TBI, skull fracture, and femur fracture.Initial work-up included a CBC, EKG which showed a normal sinus rhythm, and a mild troponin elevation of 0.187. Point-of-care ultrasound revealed a pericardial effusion. Aortic dissection was at the top of the differential. CTA findings included a medium-sized hemoperricardium with a 4 cm linear metallic object protruding into his right ventricle. The patient was immediately taken to the surgical ICU. The following morning he underwent a median sternotomy with subsequent removal of a right ventricular foreign body. His hospitalization was complicated by atrial fibrillation and was discharged on warfarin and amiodarone.DISCUSSION: At our patient's initial presentation, we were most concerned for aortic dissection versus coronary artery dissection. Unbeknownst to us, this patient had a delinquent Bard G6 filter that was never retrieved following his accident. The efficacy of prophylactic IVC filters for pulmonary embolisms in poly trauma patients has been questionable.2 The National Hospital Discharge Survey analysis has inferred a more liberal use of IVC filter placements in patients over the past two decades.3Current recommendations do not support the use of prophylactic IVC filter placement in severely injured trauma patients with expert preference now towards pharmacologic and mechanical prophylaxis.4 Unfortunately, our patient was lost to his initial follow up and hardware was never retrieved. The chance of fracture for an IVC filter is proportional to its dwell time within the patient.1That being said, it is up to the provider to be vigilant in their history taking as more of these filter complications will undoubtedly present themselves in our older trauma patients.CONCLUSIONS: The patient recovered well from his sternotomy and underwent 2 unsuccessful endovascular attempts to remove the IVC filter. The patient underwent a successful open removal of Bard G2 filter 6 months later which was complicated by a brief stay in the SICU for hypotension leading to cardiac arrest requiring multiple transfusions and minimal pressor support.Reference #1: Vijay K, Hughes JA, Burdette AS, Scorza LB, Singh H, Waybill PN, Lynch FC. Fractured Bard Recovery, G2, and G2 express inferior vena cava filters: incidence, clinical consequences, and outcomes of removal attempts. J Vasc Interv Radiol. 2012Reference #2: McMurtry AL, Owings JT, Anderson JT, Battistella FD, Gosselin R. Increased use of prophylactic vena cava filters in trauma patients failed to decrease overall incidence of pulmonary embolism. J Am Coll Surg. 1999 Sep;189(3):314-20. doi: 10.1016/s1072-7515(99)00137-4. PMID: 10472933.Reference #3: Stein PD, Kayali F, Olson RE. Twenty-one-Year Trends in the Use of Inferior Vena Cava Filters. Arch Intern Med. 2004;164(14):1541–1545. doi:10.1001/archinte.164.14.1541DISCLOSURES: No relevant relationships by John Lamb SESSION TITLE: Dyspena Mysteries SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: The chance of a mechanical failure for an IVC filter is directly proportional to its dwell time within the patient. In this case report we will discuss a rare and potentially fatal complication caused by forgotten filters. CASE PRESENTATION: A 60-year-old man presents to the emergency room after experiencing 4 days of chest pain and shortness of breath that progressively worsened after shoveling snow. Patient's past medical history is significant for tobacco use, GERD and a MVA 16 years prior that resulted in a TBI, skull fracture, and femur fracture. Initial work-up included a CBC, EKG which showed a normal sinus rhythm, and a mild troponin elevation of 0.187. Point-of-care ultrasound revealed a pericardial effusion. Aortic dissection was at the top of the differential. CTA findings included a medium-sized hemoperricardium with a 4 cm linear metallic object protruding into his right ventricle. The patient was immediately taken to the surgical ICU. The following morning he underwent a median sternotomy with subsequent removal of a right ventricular foreign body. His hospitalization was complicated by atrial fibrillation and was discharged on warfarin and amiodarone. DISCUSSION: At our patient's initial presentation, we were most concerned for aortic dissection versus coronary artery dissection. Unbeknownst to us, this patient had a delinquent Bard G6 filter that was never retrieved following his accident. The efficacy of prophylactic IVC filters for pulmonary embolisms in poly trauma patients has been questionable.2 The National Hospital Discharge Survey analysis has inferred a more liberal use of IVC filter placements in patients over the past two decades.3 Current recommendations do not support the use of prophylactic IVC filter placement in severely injured trauma patients with expert preference now towards pharmacologic and mechanical prophylaxis.4 Unfortunately, our patient was lost to his initial follow up and hardware was never retrieved. The chance of fracture for an IVC filter is proportional to its dwell time within the patient.1That being said, it is up to the provider to be vigilant in their history taking as more of these filter complications will undoubtedly present themselves in our older trauma patients. CONCLUSIONS: The patient recovered well from his sternotomy and underwent 2 unsuccessful endovascular attempts to remove the IVC filter. The patient underwent a successful open removal of Bard G2 filter 6 months later which was complicated by a brief stay in the SICU for hypotension leading to cardiac arrest requiring multiple transfusions and minimal pressor support. Reference #1: Vijay K, Hughes JA, Burdette AS, Scorza LB, Singh H, Waybill PN, Lynch FC. Fractured Bard Recovery, G2, and G2 express inferior vena cava filters: incidence, clinical consequences, and outcomes of removal attempts. J Vasc Interv Radiol. 2012 Reference #2: McMurtry AL, Owings JT, Anderson JT, Battistella FD, Gosselin R. Increased use of prophylactic vena cava filters in trauma patients failed to decrease overall incidence of pulmonary embolism. J Am Coll Surg. 1999 Sep;189(3):314-20. doi: 10.1016/s1072-7515(99)00137-4. PMID: 10472933. Reference #3: Stein PD, Kayali F, Olson RE. Twenty-one-Year Trends in the Use of Inferior Vena Cava Filters. Arch Intern Med. 2004;164(14):1541–1545. doi:10.1001/archinte.164.14.1541 DISCLOSURES: No relevant relationships by John Lamb