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(A) CT abdomen and pelvis, June 2009 demonstrating IVC filter. (B) Metallic linear density in the right ventricle, new since the CT abdomen/pelvis in 2014. This metallic density is fixed to the right ventricular wall as seen on cine images. (C) Metallic linear density in the anteromedial right middle lobe. (D/E) CT from 2020 showed that a single posterior medial limb of the IVC filter is absent making in total 10 limbs as compared to 11 limbs on comparison of 2014. This likely corresponds to a new fragment seen in the right ventricle. The IVC filter is free of filling defects. IVC distal to the IVC filter was noted to be patent. (F) Virtual colonoscopy in 2009 demonstrated 12 struts of the IVC filter.
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A metallic linear density in the RV papillary muscle, new in comparison to a 2014 CT abdomen/pelvis for renal lithiasis evaluation, was demonstrated (see Figure 1A-F). Subsequent images obtained in 2014 and 2020 revealed 11 and 10 struts, respectively (see Figure 1A-F), evidence for two distinct strut fracture embolization events.
(Left) 3D anigio view syngo.via still frame allowing visualization of the the intracardiac embolized strut (asterisk), the lung strut (top arrow) and the fracture IVC filter in the same view (bottom arrow). (Right) Embolized right ventricle strut visualized on inverted 3D MIP with vitrea workstation indicated by the arrow.
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IVC filter all in the same image (Figure 2). In review of prior imaging, 12 struts of the IVC filter were visible on a virtual colonoscopy in 2009.
(Left) Initial venogram showing a patent IVC with no intraluminal thrombus. (Right) demonstrating residual filter with some caval endothelium around the top of the filter.
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Intraoperative inspection of the filter demonstrated intact removal of the residual 10 struts (see Figure 3).