Mehanni Stephen, Higley Meghan, Schenning Ryan C
University of California San Francisco, Hospital Medicine, San Francisco, California, USA.
Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Oregon, USA.
BMJ Case Rep. 2016 Dec 23;2016:bcr2016218159. doi: 10.1136/bcr-2016-218159.
Inferior vena cava (IVC) filter use is widespread in patients with venous thromboembolism (VTE) and temporary contraindication to anticoagulation, though timely removal is often not performed. We report the case of an expectoration of an IVC filter strut. Review of the patient's prior imaging confirmed an infrarenal Bard G2 filter with an absent strut, which was visualised in the left lung base. The strut was presumed to have embolised to a pulmonary artery branch and eroded into an adjacent bronchus. Subsequent fluoroscopically guided filter retrieval was successful. The incidence of IVC filter fractures increases with longer dwell times. Filter fragment embolisation has resulted in major adverse events, including sudden death and cardiac tamponade. Recent evidence has suggested that retrieval of IVC filters with prolonged dwell times is feasible and safe. This report brings awareness to the range of complications with indwelling IVC filters, and highlights the importance of timely removal.
下腔静脉（IVC）滤器在静脉血栓栓塞症（VTE）患者及抗凝治疗存在临时禁忌证的患者中使用广泛，不过常常未及时取出。我们报告一例咳出下腔静脉滤器支柱的病例。回顾患者之前的影像学检查证实为肾下型巴德G2滤器，有一根支柱缺失，该支柱在左肺底部显影。推测该支柱栓塞至肺动脉分支并侵蚀至相邻支气管。随后在荧光透视引导下成功取出滤器。下腔静脉滤器骨折的发生率随留置时间延长而增加。滤器碎片栓塞已导致包括猝死和心脏压塞在内的严重不良事件。最近的证据表明，取出留置时间延长的下腔静脉滤器是可行且安全的。本报告提高了对留置下腔静脉滤器并发症范围的认识，并强调了及时取出的重要性。
