Broken appendage of a Günther Tulip IVC filter

Case contributed by Wajahat Ali Mohammed

Presentation

Chronic low back pain and tenderness over the mid-line lumbar spine.

Patient Data

Age: 45 years
Gender: Female

Lumbar spine radiographs

x_ray

Two Günther Tulip IVC filter strut fractures are seen with IVC filter placed at the level of L1-L2. One strut is seen fractured and has migrated 5 cm inferiorly seen in all views. Another strut is seen to be fractured and has migrated slightly superiorly best seen in the right anterior oblique view. Other findings include degenerative disk disease of L5-S1

Günther Tulip IVC Filter

Photo

Günther Tulip IVC filter. Note that there are 4 struts. Image sourced from the manufacturer website (Cook Medical)

Case Discussion

This was a Gunther Tulip IVC filter placed 17 years prior (2005) to the current radiographs due to a lower extremity DVT after knee surgery and history of MTHFR mutation. This was meant to be a temporary IVC filter, but unfortunately, it was never removed. The patient is not on any lifelong anti-coagulation despite the presence of a fractured IVC filter. There are fractures of at least two of the struts of the IVC filter. A Gunther Tulip filter should typically have 4 struts visible; all 4 can be accounted for here and should be done so via plain film imaging. Chest radiographs did not show any other displaced strut superiorly. The patient’s lower back pain is likely due to lower lumbar spondylosis and is unrelated to her fractured IVC filter.

Generally speaking, retrievable IVC filters have a hooked end and are removed within 6 months after determining that there is a low risk of a clot traveling to the lungs. If the risk of clots traveling to the lung persists and the patient has contraindications to anticoagulation, then a retrievable filter can be left in place permanently. Although these filters can still be removed several years down the line, risks and benefits have to be determined in each case. A single report has been published with the removal of Gunther Tulip IVC filter >9 years after placement1. Otherwise, in this case, the patient has had the filter in place for 17 years and it is unlikely that the filter will have to be removed simply due to it being in place for too long. 

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