Portal vein aneurysm (PVA) is a rare entity that can lead to hemorrhage or thrombosis. Although there is no standard treatment, most cases can be managed conservatively; intervention is reserved for symptomatic or enlarging aneurysms. For patients who are not surgical candidates due to cirrhosis and portal hypertension, endovascular creation of a trans-jugular intrahepatic porto-systemic shunt (TIPS) is an option to reduce portal venous pressure. This report describes a case of an enlarging PVA successfully treated with TIPS in a patient with cryptogenic cirrhosis.

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Purpose: Recent FDA safety communications have reiterated the importance of follow-up for patients with inferior vena cava (IVC) filters and removing the filters when they are no longer indicated. IVC filter retrieval rates vary widely, but overall remain low due to a variety of factors. Many of these patients are simply, "lost to follow-up." This study evaluates an automated tool to identify patients with IVC filters who present to the emergency department (ED). Materials: IRB approval was not required as the project was utilized for quality improvement. A near real-time analytics package was developed to apply natural language processing to radiology reports of all patients presenting to the ED. This package analyzes final radiology reports every 30 minutes to identify any mention of an IVC filter. The package then generates alerts which are sent to a secure cloud based dashboard for review by radiology staff. Results: Over the initial 6-month period, our system generated a total of 72 alerts, of which 70 represented valid cases of deployed IVC filters for 60 unique patients. The system detected 2.8 patients per week or 12 per month. Further chart review revealed 39/70 (56%) patients did not have indications for permanent filtration and should consider filter retrieval, 13/70 (19%) patients had some mention of a filter complication in the radiology report, and 58/70 (83%) filters were placed at another medical center. Additionally, 29/70 (41%) filters were not mentioned in the radiology report final impression and 54/70 (77%) filters were not mentioned in the ED note assessment and plan. Conclusions: Application of an automated analytic system led to the identification of a substantial number of patients with filters eligible for retrieval. The presence of an IVC filter in these patients was not routinely included in the final impression of the radiology reports or mentioned in the ED provider notes, indicating a subset of patients at risk for continued loss of follow-up.