Metal in motion: a case report of inferior vena cava filter migration

Jonathan A Aun; Edward A Hulten; Binh T Nguyen; Eric H Twerdahl

doi:10.1093/ehjcr/ytad003

Metal in motion: a case report of inferior vena cava filter migration

Eur Heart J Case Rep. 2023 Jan 6;7(1):ytad003. doi: 10.1093/ehjcr/ytad003. eCollection 2023 Jan.

Authors

Jonathan A Aun^{1

2}, Edward A Hulten^{1

2}, Binh T Nguyen^{3

2}, Eric H Twerdahl^{4

2}

Affiliations

¹ Department of Medicine, Walter Reed National Military Medical Center, Cardiology Service, 4494 Palmer Road North, Bethesda, MD 20814, USA.
² Department of Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
³ Department of Radiology, Walter Reed National Military Medical Center, Cardiology Service, 4494 Palmer Road North, Bethesda, MD 20814, USA.
⁴ Department of Vascular Surgery, Walter Reed National Military Medical Center, Cardiology Service, 4494 Palmer Road North, Bethesda, MD 20814, USA.

Abstract

Background: Inferior vena cava (IVC) filter migration, particularly to the heart, is a rare complication. Small metal fragments may be inadequately characterized on transthoracic echocardiography and may be missed entirely on chest radiograph. Managing the adverse outcomes of IVC filters is a formidable challenge as retrieval carries the risk of arrhythmia, right ventricular perforation, and damage to the tricuspid valve.

Case summary: A woman in her fifties underwent routine computed tomography (CT) calcium score screening and was found to have a metallic fragment in the right ventricle of her heart. Subsequent contrast enhanced, ECG-gated cardiac CTA was completed and images were reconstructed to yield cine images on syngo.via (Siemens, Erlangen, Germany) and vitrea workstation (version: 6.6.3; Vital, Toshiba Medical Systems) to guide heart team discussion and clinical management.

Discussion: Our case illustrates the benefit of CTA with cineography in characterizing the location, size, and extent of fragment involvement within the myocardium. Moreover, this case serves as a reminder to medical professionals to carefully consider IVC filter placement in the appropriate patient, remain vigilant regarding potential complications, and to aspire follow-up of removable filters.

Keywords: IVC filter; case report; cine images; filter fracture; vascular complications.

Publication types

Case Reports