[Pulmonary embolism despite inferior vena cava filter]

The Greenfield filter is an effective and safe means of preventing postoperative pulmonary embolism in high-risk patients. However, it does not give absolute protection. We report a 69-year-old man who presented with deep vein thrombosis. Medical work-up revealed pancreatic tumor (Trousseau's sign). The Greenfield filter was placed in the inferior vena cava before operation. 11 days after total pancreatectomy clinical signs of pulmonary embolism appeared and the diagnosis was confirmed by ventilation-perfusion scan; anticoagulant therapy was instituted. The incidence of pulmonary embolism following interruption of the inferior vena cava by introducing the Greenfield filter is low (2.2%). Nevertheless, the diagnosis of pulmonary embolism should be considered in any patient with appropriate clinical signs, regardless of whether a filter was inserted.