Case of the Week – Malfunctioning Biliary Drain

This case features a 67 year old female with pancreatic adenocarcinoma (status post pancreatic resection) who presented to the emergency department for a malfunctioning biliary drain.

A CT abdomen and pelvis was ordered by the ED clinician in which the radiologist discovered an incidental finding of a thrombus (blood clot) within the inferior vena cava that extended into the right atrium of the heart.

One of our interventional radiologists, Dr. Brian Baigorri, and our interventional radiology (ESIR) resident, Dr. Brian Covello, performed an IVC and right atrial thrombectomy. A portion of the clot was dislodged into the pulmonary artery so a pulmonary artery thrombectomy was also performed. Final images showed complete removal of the patients clot.

The clot was sent to pathology and found to be tumor thrombus (cancerous). The patient was discharged in stable condition.