Sunday, January 28, 2018

A complication of IVC filters

A woman in her 20s with ulcerative colitis presented with acute-onset left-sided pleuritic chest pain for 3 days. She had a medical history of unprovoked deep vein thromboses (DVT) and pulmonary embolism (PE) and had been taking coumadin without any issues. Ten years before, she had had a retrievable inferior vena cava filter (RIVCF) placed for intraoperative PE prophylaxis for total colectomy for ulcerative colitis. She denied being off anticoagulation medication ever or any medical history of bleeding or new thromboses while on warfarin, or during the perioperative period. The RIVCF was never removed. A computed tomographic (CT) angiography ruled out any new PE, but showed IVCF fragments in the pulmonary vasculature. Two of the 3 pieces (Figure, A) and the RIVCF (Figure, B) were removed and her pain improved. The third piece was irretrievable owing to location deep in the pulmonary vasculature. She continued to have intermittent chest pain over the next 6 months and CT showed another IVCF fragment in right atrial musculature (Figure, C) which was obscured by contrast on prior CT angiograms. The risks involved with open-heart surgery for retrieval of this fragment were discussed with the patient and she decided against any intervention. Her chest pain resolved spontaneously over the next 2 months. She continues to take coumadin without any issues.

To top it off it was done for a weak indication and could have been removed early.

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