Ann Thorac Surg 2008;85:1813. doi:10.1016/j.athoracsur.2007.12.055
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Tension Pneumothorax: A Complication of Superior Vena Cava Filter Insertion
Surya P. Bhatt, MDa,*,
Sudip Nanda, MDa,
Mohamed A. Turki, MDb
a Department of Internal Medicine, St. Luke's Hospital, Bethlehem, Pennsylvania
b Department of Pulmonary and Critical Care, St. Luke's Hospital, Bethlehem, Pennsylvania
* Address correspondence to Dr Bhatt, Department of Internal Medicine, St. Luke's Hospital 801, Ostrum St, Bethlehem, PA 18015 (Email: suryabhatt{at}gmail.com).
A 64-year-old woman who was admitted to the hospital for meningioma resection had a postoperative course complicated by parenchymal and subarachnoid hemorrhage, obstructive hydrocephalus, ventriculoperitoneal shunt insertion, ventilator-associated pneumonia with prolonged weaning, and bilateral proximal subclavian vein thrombosis. A Günther Tulip filter (Cook Inc, Bloomington, IN) was placed in the superior vena cava in view of contraindications to anticoagulation. Two days later, acute shortness of breath with hypotension requiring intubation developed in the patient. There were no signs of heart failure. A chest roentgenogram revealed right-sided pneumothorax. A chest tube was placed, which showed persistent air leak. A computed tomographic chest scan (Fig 1, Panel A: horizontal section; Panel B: coronal section) showed right pneumothorax and revealed that the strut of the filter had penetrated the lung. The filter was safely removed through a filter sheath. Superior venacavagram showed no extravasation, and the air leak subsequently stopped. A month later, the patient was discharged to a nursing home for comfort care. The protrusion of strut (>3 mm) beyond the vessel wall is significant [1]. Generally considered safe, filter penetration has caused cardiac tamponade [2] and aortic wall erosion [3]. Filter migration and rupture can occur early or late after implantation and should be considered when unexplained complications arise.
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Acknowledgments
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We thank Betsy Toole and Anne Kemp from Media Production Services for their expert help with the images.
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References
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- Cina A, Masselli G, Di Stasi C, et al. Computed tomography imaging of vena cava filter complications: a pictorial review Acta Radiol 2006;47:135-144.[Medline]
- Hussain SM, McLafferty RB, Schmittling ZC, et al. Superior vena cava perforation and cardiac tamponade after filter placement in the superior vena cava—a case report Vasc Endovascular Surg 2005;39:367-370.[Abstract/Free Full Text]
- Cousins GR, DeAnda Jr A. Images in cardiothoracic surgery. Superior vena cava filter erosion into the ascending aorta. Ann Thorac Surg 2006;81:1907.[Free Full Text]
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