Migration of Fragments of Inferior Vena Cava Filter to Heart and Lung

Inferior vena cava filters are used in patients with recurrent pulmonary embolism and/or deep vein thrombosis who have contraindications to anticoagulation or in whom it has failed. Common complications are related to vascular access and deployment; less frequent complications include mechanical failure such as filter strut fracture.

We present the case of a 58-year-old woman who had severe cough followed by expectoration of a metallic fragment identified as a fractured strut of a previously implanted inferior vena cava filter (in 2014) (Celect, Cook Medical). A second filter (OPTEASE, Cordis) was implanted in 2016 after unsuccessful retrieval. Computed tomography revealed 2 additional struts in the lungs and a third in the heart, without ventricular communication, myocardial dysfunction, or valvular abnormalities. The patient remained asymptomatic, declined surgery, and has been clinically stable for >8 years of follow-up.

This case highlights the importance of multimodality imaging and individualized multidisciplinary approach. Early recognition is crucial to prevent severe complications.

Maintain a high index of suspicion for IVC filter migration of fractured struts, and consider multimodality imaging in challenging cases for decision making and follow up.