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Delayed Pneumothorax Following Superior Vena Cava Filter Placement FREE TO VIEW

Haytham Adada, MD; Souheil Abdel Nour, MD; Mahmoud Amarna, MD; Wael El Minaoui, MD; Ryland Byrd, MD; Thomas Roy, MD
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East Tennessee State University, Johnson City, TN

Chest. 2013;144(4_MeetingAbstracts):896A. doi:10.1378/chest.1691516
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SESSION TITLE: Miscellaneous Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: The published experience is very limited regarding superior vena cava (SVC) filters. Increased placement of these filters in patients with upper extremity deep venous thrombosis has resulted in increased reported complications. We report a case of delayed pneumothorax following SVC filter placement

CASE PRESENTATION: A 70 year-old male patient admitted with hemorrhagic stroke had a prolonged hospital course requiring the placement of a peripherally inserted central venous catheter (PICC). A progressive swelling of his right arm led to a Doppler ultrasound, revealing a deep venous thrombosis (DVT) extending into the right subclavian vein. Due to the recent intracranial bleed, a decision was made to insert an SVC filter. Under sonographic guidance, the right internal jugular vein was catheterized and a retrievable ECLIPSETM SVC filter was placed. The procedure was performed under fluoroscopy with no complication noted during or immediately after the intervention. The patient was transferred to a nursing facility a few hours after the procedure. The following day the patient began complaining of progressive dyspnea. A repeat chest X-ray revealed a right-sided pneumothorax (Fig. 1). A computed tomography of the chest showed a right-sided pneumothorax with the strut of the filter perforating the SVC and the pleura (Fig. 2). The PICC line was removed and a chest tube was inserted. Re-expansion of the lung was accomplished and secured with talc pleurodesis

DISCUSSION: Percutaneous SVC filter placement is reported in the literature as a safe and effective method for preventing pulmonary emboli as a complication of upper extremity DVT. A single case report has documented this rare complication of a pneumothorax occurring in a delayed fashion after 48 hours. Pneumothorax following SVC placement can be immediate as seen in other invasive procedures or delayed, as seen in this patient

CONCLUSIONS: Pneumothorax is a potential complication of SVC filter placement and should not be excluded based solely on immediate post-operative imaging. Close monitoring and repeat X-rays can improve outcomes and even be life-saving for patients developing delayed pneumothorax

Reference #1: Bhatt SP et al. Tension pneumothorax: a complication of superior vena cava filter insertion. Ann Thorac Surg. 2008 May; 85(5):1813

Reference #2: Usoh F, Hingorani A, et al. Long-term Follow-up for Superior Vena Cava Filter Placement. Ann Vasc Surg. 2009 May-Jun; 23(3):350-4

DISCLOSURE: The following authors have nothing to disclose: Haytham Adada, Souheil Abdel Nour, Mahmoud Amarna, Wael El Minaoui, Ryland Byrd, Thomas Roy

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