Intravascular ultrasound-guided retrieval of a fish bone embedded in the inferior vena cava: a case report

Abstract Background Intravascular migration of ingested fish bones is an exceptionally rare complication that may result in thrombosis or embolic events. We report a case of inferior vena cava thrombosis caused by fish bone migration successfully managed by IVUS-guided endovascular retrieval. Case presentation A 70-year-old woman with stage IV cholangiocarcinoma presented with night sweats, chills, and abdominal pain. Contrast-enhanced CT demonstrated focal inferior vena cava thrombosis containing a linear hyperdense foreign body extending into a renal vein, associated with inflammatory changes adjacent to the duodenum and segmental pulmonary embolism. Fluoroscopic visualization was limited. IVUS enabled precise localization of the foreign body within the thrombus. After unsuccessful snare retrieval attempts, the fish bone was successfully removed using rat-tooth forceps under combined fluoroscopic and real-time IVUS guidance. The patient was discharged asymptomatic on oral anticoagulation planned for 6 months. One-month follow-up CT confirmed complete resolution of inferior vena cava thrombosis and inflammatory changes, with no need for further foreign body-related intervention. Conclusions IVUS facilitates retrieval of intravascular foreign bodies embedded within venous thrombus, particularly when fluoroscopic visualization is poor, and can assist in selecting alternative retrieval strategies when conventional snares fail.