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Mystery ring: a case of TIPS stent migration
  1. Murad Abdelsalam1,
  2. Sruthi Vellanki2,
  3. Anup Kumar Ashwini Kumar Trikannad2,
  4. Michele Degregorio1
  1. 1 Department of Cardiology, Saint Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA
  2. 2 Department of Internal Medicine, Saint Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA
  1. Correspondence to Dr Murad Abdelsalam, Murad.abdelsalam{at}

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We present a 50-year-old man with history of end-stage liver disease secondary to hepatitis C, who frequently presents to the hospital with ascites. He recently underwent Trans jugular Intrahepatic Portosystemic Shunt (TIPS) stent placement after becoming resistant to diuresis and large volume therapeutic paracentesis. He presented to the emergency room with altered mental status due to hepatic encephalopathy. On physical exam, he was noted to have a systolic murmur; hence, a transthoracic echocardiogram was ordered. It showed an echo dense ring-like shadow in the right …

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