When an unidentified foreign object appears in the inferior vena cava: recognizing the presence of TIPS stent on transthoracic echocardiographic imaging

We describe the case of 65-year-old female with a history of hypertension, diabetes, and cirrhosis. In the subcostal view on a routine transthoracic echocardiogram (TTE), she is found to have an unidentified round prosthetic appearing object in the inferior vena cava (IVC). Upon further investigation, the object was identified as a transjugular intrahepatic portosystemic shunt (TIPS) stent, which was seen in cross section in a hepatic vein draining into the IVC. Most echocardiographers are unfamiliar with the appearance of a TIPS on TTE. Being able to recognize this will help avoid misdiagnosis and unnecessary further imaging.