Incidental discovery and surgical removal of inferior vena cava filter fragment embolization to the right ventricle with pericardial perforation during coronary angiography: a case report.

BACKGROUND

Retrievable inferior vena cava (IVC) filters, when not removed after the period of thromboembolic risk has resolved, are prone to delayed complications such as limb fracture, migration, and embolization. Fragment embolization to the heart can result in pericardial penetration or other life-threatening sequelae yet may remain entirely asymptomatic and identified only incidentally.

CASE SUMMARY: A 54-year-old woman with a retrievable IVC filter placed in 2009 for pulmonary embolism, during a period of high bleeding risk from active breast cancer treatment, underwent elective left heart catheterization in 2025 for a 2-month history of chest discomfort. Coronary computed tomography (CT) angiography revealed multi-vessel coronary artery disease but did not visualize the migrated filter strut. During angiography, a linear radiopaque foreign body was seen within the right ventricle. A kidney-ureters-bladder radiograph confirmed filter fracture with a missing limb. Echocardiography 2 months earlier showed preserved bi-ventricular function and no pericardial effusion. During coronary artery bypass grafting, a fractured metallic filter limb ∼1-2 cm in length penetrating the pericardium was surgically removed. The remaining filter was left in situ with planned radiographic surveillance. Recovery was uneventful.

DISCUSSION: Thin metallic struts may evade CT detection due to in-plane alignment or artefact, and echocardiography may fail to identify fragments lacking haemodynamic significance. Management options include endovascular retrieval, surgical extraction, or observation. This case highlights the importance of structured IVC filter follow-up and timely retrieval to prevent silent but potentially life-threatening complications.