An Uncommon Cause of Shock: Acute Thrombosis of the Inferior Vena Cava.

BACKGROUND

Obstructive shock is an uncommon presentation to the emergency department (ED) and is most often caused by an acute pulmonary embolism. A very rare cause of obstructive shock is extensive deep venous thrombosis, otherwise known as phlegmasia cerulea dolens. We present a case of obstructive shock caused by placement of an inferior vena cava filter complicated by acute occlusion with extensive deep venous thrombosis.

CASE REPORT: A 57-year-old man presented to the ED with hypotension, lethargy, and chronic leg pain. The day prior he had an inferior vena cava filter placed and was taken off his anticoagulation approximately 1 week prior. Massive pulmonary embolism was excluded as the cause based on point-of-care ultrasound showing absence of right heart strain. His initial resuscitation and evaluation did not determine the cause of his shock and he was empirically treated for sepsis. After adequate blood pressure was achieved with norepinephrine, his lower extremities were noted to be cyanotic and an ultrasound revealed the diagnosis of phlegmasia cerulea dolens. The shock state resolved after catheter-directed thrombolysis. Why Should an Emergency Physician Be Aware of This? Although unique, this case highlights an alternative cause of obstructive shock and informs emergency physicians about a potential deadly complication of a common procedure.