CASE PRESENTATION: A 61-year-old woman presented to our hospital with complaints of acute onset low back pain which she decribed as a “pop” associated with bilateral lower extremity weakness and difficulty walking for one day. Her medical history was significant for PE and DVT requiring IVC filtration due to complications from anticoagulation. On physical examination, she had 5/5 strength in all extremities, normal sensation, reflexes, and an unsteady gait. A computed tomography of the head and magnetic resonance imaging of the cervical, thoracic and lumbar spine were normal. On the medical floor, she had a syncopal episode and was found to be cold, diaphoretic, hypotensive and tachycardic. ECG showed sinus tachycardia with hyperacute T waves in all leads and ST segment elevations in leads III and aVF. Treatment for acute myocardial infarction was started. However, she decompensated and went into cardiac arrest. Advanced cardiovascular life support (ACLS) was initiated and alteplase was administered given the concern for acute PE. The family ultimately opted to terminate resuscitative measures and requested an autopsy. The autopsy revealed an IVC filter with one prong penetrating the IVC wall extending into the aortic lumen. Approximately, 300 milliliters of intraperitoneal and intrapelvic clotted blood was found. The pulmonary vessels were patent and the coronary arteries had mild atherosclerosis.