Perforation of inferior vena cava by inferior vena cava filter.

A 46-year-old male with diabetes, hypertension, and a history of pulmonary embolism (status post placement of a retrievable Celect inferior vena cava [IVC] filter) presented to the emergency department with progressively worsening abdominal pain for 1 month. Physical exam was consistent with right upper quadrant and right lower quadrant abdominal pain and tenderness, without rebound or guarding, and with stable vital signs. A computed tomography (CT) of the abdomen was performed.

CT demonstrated that multiple struts of the IVC filter were located outside the lumen of the inferior vena cava, suggestive of chronic perforation with no evidence of free fluid or hematoma in the abdomen. IVC perforation from removable filters is relatively common, and directly related to how long the filter has been in place.1 One study noted an 86% perforation rate overall, with all filters imaged after 71 days revealing some level of perforation.1 This patient’s IVC filter had been in place for four and a half months. Complications of IVC filters include filter migration, tilting, strut fracture, strut perforation, and IVC thrombosis.2 Most strut perforations are discovered incidentally.2

The patient’s pain was later attributed to cholecystitis based upon his laboratory and imaging study results. The patient subsequently had the IVC filter removed by interventional radiology, and a new filter was placed without complications.