Critical Care and Shock

The migrating filter: Inferior vena cava to superior vena cava

A 75-year-old male with past medical history significant for severe chronic obstructive pulmonary disease was admitted to the intensive care unit with respiratory failure. He was found to have an acute deep venous thrombosis (DVT) and pulmonary embolus (PE). A permanent vena cava filter was deployed in the infrarenal inferior vena cava (IVC) at L3 level. A new cavogram confirmed the position of the filter in the inferior vena cava with tip of the filter at the level of the inflow of the left renal vein. Thirty minutes post placement, a routine chest x-ray revealed migration of the filter into the superior vena cava (Figure 1). Unsuccessful attempts were performed to remove the filter through the right internal jugular vein. The patient remained asymptomatic with stable vital signs, no pain or distress. It was elected to leave the migrated inferior vena cava filter in the superior vena cava.

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