Oredegbe Al Ameen, Derakhshesh Matthew, Waqar Hafiza Hareem, Alderisio William
Internal Medicine, Albany Medical College, Albany, USA.
Internal Medicine, Albany Medical Center, Albany, USA.
Cureus. 2023 Jun 27;15(6):e41046. doi: 10.7759/cureus.41046. eCollection 2023 Jun.
A 58-year-old male with an unknown medical history presented with acute encephalopathy, receptive aphasia, and hypertensive emergency. The patient did not have any family members from whom a collateral history could be obtained. He underwent X-rays of the abdomen and bilateral humeri/femurs to check for foreign bodies. He was found to have right femoral open reduction and internal fixation with retained screw fragments. He was diagnosed with ischemic stroke on MRI. Transthoracic echocardiogram (TTE) revealed right-sided heart failure and a tricuspid valve mass as well as right to left shunting. This raised concern for large atrial septal defect (ASD) with paradoxical embolization from tricuspid valve mass. Transesophageal echocardiogram (TEE) redemonstrated large ASD. Concern was raised for the ASD closure device as the cause of this "tricuspid mass." Due to history of orthopedic procedure, it was hypothesized that the patient had an IVC filter placed in the setting of pulmonary embolism (PE) prior to an orthopedic procedure. The tricuspid valve was visualized under fluoroscopy and was confirmed to be a migrated IVC filter. He was taken to the operating room (OR) for cardiac surgery for the removal of the IVC filter and repair of ASD. Surprisingly, no ASD was found.
一名58岁男性，病史不明，出现急性脑病、感受性失语和高血压急症。患者没有可获取旁系病史的家庭成员。他接受了腹部及双侧肱骨/股骨X线检查以排查异物。结果发现他曾接受右股骨切开复位内固定术，有螺钉碎片残留。MRI检查诊断为缺血性卒中。经胸超声心动图（TTE）显示右心衰竭、三尖瓣肿物以及右向左分流。这引发了对大型房间隔缺损（ASD）合并三尖瓣肿物反常栓塞的担忧。经食管超声心动图（TEE）再次证实存在大型ASD。人们开始怀疑ASD封堵装置是导致这个“三尖瓣肿物”的原因。鉴于患者有骨科手术史，推测患者在骨科手术前因肺栓塞（PE）放置了下腔静脉滤器。在荧光透视下观察三尖瓣，证实其为移位的下腔静脉滤器。他被送往手术室接受心脏手术，取出下腔静脉滤器并修复ASD。令人惊讶的是，并未发现ASD。
