Migration of a fractured inferior vena cava filter strut to the right ventricle of the heart

Abstract

Inferior vena cava (IVC) filters are increasingly used in patients with recurrent venous thromboembolism in whom anticoagulation is contraindicated or intolerable. Migration of fragments is a known complication of IVC filter use. We present a case of a 32-year-old man, who presented with right-sided chest pain believed to be caused by a migrated IVC fragment to the right ventricle. The filter was removed by an endovascular cook forceps with the assistance of intracardiac echocardiography. This case serves as an addition to the existing reports of successful removal of intracardiac fragments via minimally invasive endovascular approach, amid a larger number of intracardiac fragments that have been removed by an open-heart approach.

Keywords: interventional cardiology; pulmonary embolism; venous thromboembolism.

Figure 1

Chest X-ray showing two linear metallic foreign bodies, one in the anterior aspect of the heart (horizontal radiopaque line within the centre oval) and the other in the right upper abdomen (parallel to the yellow line). The peripheral piece measures about 3.5 cm which corresponds to the entire length of the primary filter strut.

Figure 2

X-ray abdomen showing a broken strut (yellow arrow) with its distal piece missing, a second fractured strut with the piece lying just caudal to the inferior vena cava filter (green arrows), an unfractured intact strut and a completely missing fourth strut. Six of the original seven thinner legs are intact, with the seventh missing.

Figure 3

Coronal view X-ray of the abdomen showing a radiopaque foreign body involving the right deep lateral costophrenic sulcus. The green arrow indicates the two pieces of a fractured strut.

Figure 4

CT chest showing a radiopaque foreign body in the region of the right atrioventricular junction. The green arrow indicates a radiopaque filter fragment in the right lateral deep costophrenic sulcus, seen on chest CT.

Figure 5

CT angiogram of the chest showing a metallic linear structure (green arrows) located along the right ventricular free wall anteriorly and the base of the ventricle posteriorly, with possible protrusion through the right ventricular free wall.

Figure 6

CT abdomen without contrast showing the medial most primary filter strut (3) extending through the inferior vena cava wall into the retroperitoneum and lying just anterior to the aorta. Inferior filter strut (2) is seen embedded in the L3 vertebral body and encased by bony excrescences which also encase one or possibly two secondary struts (thinner legs).