Disclosures: Mark E. Tornero, MD: Nothing to disclose

Case Description: A 41-year-old male with chronic low back pain sustained a stroke and eventually transitioned to inpatient rehabilitation. He reported a flare up of his back pain while in acute care, due to being less active. As therapies ensued, his discomfort progressed and his ability to participate in therapies decreased. Preliminary testing and imaging were benign and confirmed multilevel degenerative changes of his spine. His physical exam was also benign and he was still tolerating meals. However back pain began limiting functional improvements.

Setting: Tertiary center.

Patient  41-year-old male with a right hemispheric stroke.

Assessment/Results: Due to decreased participation in therapies and functional limitations, advanced imaging was contemplated, and in particular whether or not to expose the patient to IV contrast and its potential risks. Of note, this individual was extremely hesitant to undergo IV contrast procedures from prior negative experiences. Ultimately an abdominal and pelvis CT scan with contrast was performed and demonstrated an obstructed IVC filter due to massive blood clot burden, which was unexpected given the patient was on prophylactic heparin during his immediate hospitalization and without physical exam findings for this condition.

Discussion: The diagnosis of a thrombosed IVC filter was not expected, given this individual had no physical exam findings nor pain in the lower limbs that is indicative for this condition, and he was also on heparin prophylaxis during acute care. After a literature review we were surprised to find one study citing a 22% incidence rate of vena cava thrombosis. After the discovery treatment interventions were pursued and he had improvements in his symptoms, participation with therapies, and quality of life.

Conclusion: This was a fortunate example of an imaging risk exposing a patient to contrast to determine an unexpected diagnosis. Thrombosed IVC filters should be considered in the differential despite lack of concomitant findings on physical exam.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/chronic-low-back-pain-differential-considerations-when-function-is-not-improving-as-expected/