PDF(Pubmed)
Abstract：
A 58-year-old male with an unknown medical history presented with acute encephalopathy, receptive aphasia, and hypertensive emergency. The patient did not have any family members from whom a collateral history could be obtained. He underwent X-rays of the abdomen and bilateral humeri/femurs to check for foreign bodies. He was found to have right femoral open reduction and internal fixation with retained screw fragments. He was diagnosed with ischemic stroke on MRI. Transthoracic echocardiogram (TTE) revealed right-sided heart failure and a tricuspid valve mass as well as right to left shunting. This raised concern for large atrial septal defect (ASD) with paradoxical embolization from tricuspid valve mass. Transesophageal echocardiogram (TEE) redemonstrated large ASD. Concern was raised for the ASD closure device as the cause of this \"tricuspid mass.\" Due to history of orthopedic procedure, it was hypothesized that the patient had an IVC filter placed in the setting of pulmonary embolism (PE) prior to an orthopedic procedure. The tricuspid valve was visualized under fluoroscopy and was confirmed to be a migrated IVC filter. He was taken to the operating room (OR) for cardiac surgery for the removal of the IVC filter and repair of ASD. Surprisingly, no ASD was found.
摘要：
一名58岁男性，病史不详，出现急性脑病，接受性失语症,和高血压急症。患者没有任何可以获得附带病史的家庭成员。他接受了腹部和双侧肱骨/股骨的X射线检查，以检查异物。发现他有右股骨切开复位和内固定，并保留了螺钉碎片。他在MRI上被诊断为缺血性中风。经胸超声心动图（TTE）显示右侧心力衰竭和三尖瓣肿块以及从右到左分流。这引起了人们对三尖瓣肿块引起的大房间隔缺损（ASD）的矛盾栓塞的关注。经食管超声心动图（TEE）重新显示了大ASD。引起人们对ASD闭合装置的关注，这是造成三尖瓣肿块的原因。“由于骨科手术的历史，假设患者在骨科手术前在肺栓塞(PE)环境中放置了IVC过滤器.在荧光镜下观察三尖瓣，并确认为迁移的IVC过滤器。他被带到手术室（OR）进行心脏手术，以去除IVC过滤器并修复ASD。令人惊讶的是,没有发现ASD。
