Thrombosed left-sided (transposed) IVC filter
Abdominal pain and leg swelling months after insertion of IVC filter for recurrent PE
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Left-sided IVC with a filter in the IVC terminating at the left renal vein and IVC as it crosses to the right. Filling defect (consistent with thrmobus) in the IVC proximal to the filter extending into the iliac veins, best seen on the arterial but confirmed on the portal venous phase.
It is important to differentiate flow phenomena (mixing of contrast opacified and unopacified blood) in the IVC from clot. This is more difficult in the early phases of dynamic scanning thus persistent filling defect = clot should be confirmed on later venous phases. IVC filters are prone to thrombosis that can propagate distally.