Methodist Journal

FEATURED GUEST EDITOR

ISSUE INTRO

The Burgeoning Field of Cardio-Oncology

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RECOGNITIONS

Barry H. Trachtenberg Leads Issue on Cardio-Oncology

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REVIEW ARTICLES See More

Heart Failure in Relation to Anthracyclines and Other Chemotherapies

Heart Failure in Relation to Tumor-Targeted Therapies and Immunotherapies

The Role of Cardiovascular Imaging and Serum Biomarkers in Identifying Cardiotoxicity Related to Cancer Therapeutics

Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity

Cardiovascular Toxicities of Radiation Therapy

Electrophysiologic Complications in Cancer Patients

Vascular Toxicity in Patients with Cancer: Is There a Recipe to Clarify Treatment?

Future Directions in Cardio-Oncology

CASE REPORTS See More

A Rare Case of Pancreatitis-Induced Thrombosis of the Aorta and Superior Mesenteric Artery

Anomalous Origin of the Right Coronary Artery from the Left Main Coronary Artery in the Setting of Critical Bicuspid Aortic Valve Stenosis

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Do Not Pass Flow: Microvascular Obstruction on Cardiac Magnetic Resonance After Reinfarction Following Primary Percutaneous Coronary Intervention

CLINICAL PERSPECTIVES See More

EXCERPTA

Cardio-Oncology, Then and Now: An Interview with Barry Trachtenberg

POINTS TO REMEMBER

Onconephrology: An Evolving Field

POINTS TO REMEMBER

Herbal Nephropathy

EXCERPTA

Rolling the Dice on Red Yeast Rice

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

Vol 10, Issue 3 (2014)

Article Full Text

CASE REPORTS

It Wasn't Cupid: Multimodality Imaging of Inferior Vena Cava Filter Fracture with Strut Migration to the Interventricular Septum

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Article Citation:

Mahwash Kassi, Jose Lopez, Colin Barker, Scott Trerotola, Neal Kleiman, and Karla Kurrelmeyer. It Wasn’t Cupid: Multimodality Imaging of Inferior Vena Cava Filter Fracture with Strut Migration to the Interventricular Septum. Methodist DeBakey Cardiovascular Journal: September 2014, Vol. 10, No. 3, pp. 198-200.

doi: https://doi.org/10.14797/mdcj-10-3-198

Case Report

Inferior vena cava (IVC) filter fracture with strut embolization is a rare and serious complication of IVC filters.1 Embolization to the heart is associated with grave consequences, including tamponade, ventricular arrhythmias, and sudden death. Currently, a paucity of literature consisting of case reports and case series exists to guide the clinician in diagnosis and management decisions. Transthoracic echocardiography and fluoroscopy are the imaging modalities routinely used to guide the clinician. However, these techniques may have insufficient resolution to establish the correct diagnosis and determine the appropriate treatment strategy. Multidetector computed tomography may have superior diagnostic value in these patients. Here, we present a case demonstrating the importance of multimodality imaging in assisting diagnosis and treatment decisions in patients with IVC filter fracture.

Figures 1 and 2. Chest X-ray. A 26-year-old paraplegic woman referred to the cardiology clinic for chest pain was found to have a metallic density in her heart on chest X-ray (both figures). A recoverable inferior vena cava filter had been placed prophylactically at another hospital 3 years ago following an automobile accident. Anteroposterior view (left) and lateral view (right) reveal a metallic density in the heart (green arrows).
Figures 3 and 4. Transthoracic echocardiogram. Apical 4-chamber view (left) and apical 5-chamber view (right) of her transthoracic echocardiogram revealed a metallic wire in the mid-muscular interventricular septum. It is unclear whether the wire extends into the left ventricular cavity. Also, refer to Online Videos 1 and 2 that correspond to the left and right panels, respectively.
Figure 5. Cardiac multidetector computed tomography (MDCT). Cardiac MDCT revealed that about two-thirds of the metallic wire was embedded in the muscular interventricular septum and one-third extended into the right ventricular cavity. The wire did not extend into the left ventricular cavity. However, it did bend during systole and straighten during diastole (Online Videos 3 and 4).
Figure 6. Cardiac multidetector computed tomography. Three-dimensional reconstruction of the heart with the outer wall of the right ventricle removed again demonstrated a portion of the wire extended into the right ventricular cavity. The wire did not involve the coronary arteries (Online Video 5) and therefore was suitable for percutaneous removal.
Figure 7 and 8. Abdominal computed tomography (CT) scan. Review of her previous abdominal CT scan performed several months earlier for recurrent abdominal pain revealed an inferior vena cava filter with 12 struts.
Figure 9 and 10. Abdominal computed tomography (CT) scan. Another abdominal CT scan obtained 2 months after the first abdominal CT scan shown in Figures 7 and 8 revealed that the inferior vena cava filter now has 11 struts.
Figure 11. Fluoroscopy. Fluoroscopy revealed correct positioning of the inferior vena cava filter. However, the filter was embedded in the wall of the inferior vena cava.
Figure 12. Fractured inferior vena cava filter (IVC). The fractured IVC filter was successfully removed percutaneously using bronchoscopic forceps.
Figure 13. Embolized strut. The embolized strut was successfully retrieved percutaneously from the interventricular septum using a snare technique guided by fluoroscopy.
References

1. Nicholson W , Nicholson WJ , Tolerico P , Taylor B , Solomon S , Schryver T , et al. Prevalence of fracture and fragment embolization of Bard retrievable vena cava filters and clinical implications including cardiac perforation and tamponade. Arch Intern Med. 2010 Nov 8;170(20):1827–31. [Crossref]

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