Acute Refractory Hypotension 24 Hours Post-Inferior Vena Cave Filter Insertion Complicated by Early Phlegmasia

摘要: We present a case of 67-year-old man with T4aN3bM0 gastric adenocarcinoma who developed refractory hypotension 24 hours postinferior vena cave filter (IVCF) insertion for new finding pulmonary embolism (PE) and ongoing melena stool. After 18 aggressive 20 L intravenous fluid resuscitation in the ICU followed by vasopressors antibiotics, point-of-care echocardiography did not reveal right ventricular strain non-contrast CT scan abdominal pelvis was reported as remarkable. But his lower limbs became progressively edematous swollen while upper limb maintained its normal circumference. At post-ICU admission, had worsened severe pain pallor. The compartmental pressure measurements were high ranges. morning rounds, complete occlusion IVCF causing hypovolemic shock considered re-review abdomen showed collapsed IVC above IVCF. below distended, common external iliac veins bilaterally concerning extensive venous thrombosis early phlegmasia cerulea dolens (PCD). patient treated local catheterdirected thrombolysis thrombus maceration aspiration localized direct tissue plasminogen activator (tPA) infusion systemic heparin infusion. patient’s resolved quickly surgery to remove tumor 8 days post-IVCF insertion. placement known malignancy can greatly increase risk additional formation. our speed is unprecedented, which cava (VCT) occurred at site mechanism rare. consideration PCD worsening discoloration remains rare but important differential diagnosis.