A Case Report of a Migrated Pelvic Coil Causing Pulmonary Infarct in an Adult Female

Abstract

Introduction: It is possible but rare for a pelvic coil to migrate to the pulmonary vasculature, which can cause cardiac damage, arrhythmias, pulmonary infarct, and thrombophlebitis. The few cases reported typically do not describe removal of the coils, as patients were asymptomatic. Case report: A 39-year-old female with recent coil embolization of her left internal iliac and ovarian veins for pelvic congestion syndrome presented with one month of right-sided chest pain and dyspnea. Imaging revealed a migrated pelvic coil in the patient’s right main pulmonary artery with pulmonary infarcts and a pleural effusion. Conclusion: Interventional radiology successfully removed the coil endovascularly, with significant symptom improvement. This prevented a more-invasive open surgical procedure and resolved symptoms without requiring long-term anticoagulation or monitoring.

Choosing the Most Appropriate Treatment Option for Pelvic Venous Disease: Stenting versus Embolization

“…Major complications from this procedure include pulmonary embolism, deep venous thrombosis, and embolic material in the lung vasculature. 26 Recurrence has recently been reported to be 5%. 25 The effect on fertility is not well studied, but successful pregnancies in patients have been reported following ovarian vein embolization.…”

Incidental Finding of an Asymptomatic Migrated Coil to the Right Ventricle Following Pelvic Vein Embolisation

“…Patients in this group could present at a later date with complications of coil migration, such as arrhythmias, thrombus, cardiac valve dysfunction or haemopericardium. 2,3,10 To the best of our knowledge, the underreporting of coil migration rates has not previously been discussed in the literature. Post-PVE screening at 6 weeks could help to prevent future complications of undetected migrated coils and improve the accuracy of documented migration rates.…”

“…Multiparous and premenopausal women are at greater risk of developing PVC and its prevalence is in the range of 15-30%. [1][2][3] PVC can be managed conservatively with analgesia, through surgical ligation or alternatively with interventional PVE. PVE has been shown to be an effective treatment in women with chronic pelvic pain resulting from pelvic venous disorders.…”

“…PVE has been shown to be an effective treatment in women with chronic pelvic pain resulting from pelvic venous disorders. 1,3 The embolic agents used can vary between coils, glue, vascular plugs, foam and liquid sclerosants, with some clinicians advocating the combined use of coils and sclerosing agents. Current clinical evidence is insufficient to compare the outcomes between the use of coils alone and in combination.…”

“…5 PVE has been found to be efficacious in the management of PVC, with improvement in symptoms seen in 70-90% of patients. 3,6 The complications associated with PVE include bleeding, venous perforation and coil migration. Coil migration can be an immediate or delayed complication.…”