Makaryus Mina, Sahni Sonu, Kumar Arjun, Shah Rakesh D, Cohen Stuart L, Mehrishi Sandeep, Talwar Arunabh
Northwell Health Department of Pulmonary, Critical Care, & Sleep Medicine New Hyde Park, NY United States.
Touro College of Osteopathic Medicine Department of Primary Care New York, NY United States.
J Acute Med. 2017 Jun 1;7(2):87-91. doi: 10.6705/j.jacme.2017.0702.008.
Cardiac tamponade, if not recognized and treated immediately, is a life threatening condition with various etiologies. Most common causes of cardiac tamponade encountered in emergency rooms are due to trauma, post myocardial infarction wall rupture, cancer and all other causes of pericardial effusion. Iatrogenic causes of cardiac tamponade include anticoagulation and procedures related. Currently there is a general comfort level amongst physicians that inferior vena cava (IVC) filters are not associated with significant complications. However, one of the feared life-threatening immediate complications of IVC filter placement is complete migration of the filter to the heart, with possible risk for cardiac arrhythmia, cardiac tamponade, and death. IVC filter strut fracture and migration to the heart and pulmonary arteries is another possible cause of cardiac tamponade and needs to be added to the differential diagnosis in the setting of tamponade signs and symptoms in a patient with history of IVC filter placement. We present a case of IVC filter strut fracture and migration to the right ventricle with penetration of the free wall causing cardiac tamponade with subsequent successful percutaneous retrieval. We hope to raise awareness through this case of the rare but potentially fatal complications of IVC filter placement and to advise regarding the judicious use of IVC filters.
心脏压塞若未被及时识别和治疗，是一种由多种病因引起的危及生命的状况。急诊室中遇到的心脏压塞最常见原因是创伤、心肌梗死后室壁破裂、癌症以及所有其他导致心包积液的原因。心脏压塞的医源性原因包括抗凝及相关操作。目前医生们普遍认为下腔静脉（IVC）滤器不会引发严重并发症。然而，IVC滤器置入令人担忧的即刻危及生命的并发症之一是滤器完全迁移至心脏，可能存在心律失常、心脏压塞及死亡风险。IVC滤器支柱骨折并迁移至心脏和肺动脉是心脏压塞的另一个可能原因，在有IVC滤器置入史且出现心脏压塞体征和症状的患者中，这一情况应列入鉴别诊断。我们报告一例IVC滤器支柱骨折并迁移至右心室，穿透游离壁导致心脏压塞，随后经皮成功取出滤器的病例。我们希望通过此病例提高对IVC滤器置入罕见但可能致命并发症的认识，并就IVC滤器的合理使用提出建议。
