Hypophysitis due to IgG4-related disease usually demonstrates prompt response to corticosteroids. This case highlights the need to image promptly after starting treatment to exclude an enlarging pituitary mass despite corticosteroid treatment. Alternative therapy with azathioprine can result in marked improvement. It should be remembered that IgG-4 related hypophysitis is part of a multi-organ disease.

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Background Inferior vena cava (IVC) filters are increasingly used to treat venous thromboembolism when there are contraindications or failure to respond to anticoagulant therapy. Retrievable filters were introduced to avoid long‐term complications and risks associated with permanent filters. However, failure to follow up patients appropriately can lead to low retrieval rates. Aims To examine the practice of our institution in using retrievable IVC filters and to provide a review of published literature. Methods Retrospective audit of medical records in a single medical institution. Results Forty‐one patients had retrievable IVC filters inserted. The median age of patients was 67. The majority (78%) of patients had filters inserted for presence of venous thromboembolism and contraindication to anticoagulation. Twenty‐five (61%) patients received no clinical follow up. Factors associated with loss to follow up include a lack of documentation for retrieval plan (P < 0.01), lack of haematology outpatient clinic review (P < 0.01) and age greater than 50 years (P < 0.01). Procedural success was achieved in nine of 11 attempted filter removals. Eighteen complications were noted among patients. IVC filter insertion failed to prevent recurrent pulmonary embolisms in three patients. Conclusions Majority of retrievable IVC filters will become lost to clinical follow up. Rates of attempted retrieval within 1 year of filter insertion are low. Loss to follow up is associated with older age, lack of documentation and lack of haematology clinic review post discharge. This study highlights the importance of a structured system to document clearly the review and retrieval plans for patients with IVC filters, at the time of initial insertion.

The use of thromboprophylaxis was high in our centre, and the incidence of VTE was low when patients received a median of 8 days pharmacological prophylaxis combined with mechanical prophylaxis. The VTE incidence of 4% is similar to previous studies using extended prophylaxis. Our study findings do not support changing local protocol to extended prophylaxis.

Key Clinical MessageWe need to have a high index of suspicion for subdural hemorrhage (SDH) post-lumbar puncture in hematological patients given their increased risk and the significant morbidity and mortality associated with SDHs.