Partial or complete occlusion of pulmonary vessels due to reasons other than thrombosis is called nonthrombotic pulmonary embolism (NTPE).[1, 2] The incidence is low, but it can lead to serious pulmonary problems. Since there are no specific clinical, laboratory and radiological findings, it can be difficult to diagnose. A 44-year-old female patient underwent a series of tests due to a suspicious object seen in her chest X-ray during routine screening ( Figure 1). A coil-shaped foreign object was observed in the right middle zone in the chest X-ray, and the patient's clinical and laboratory findings were within normal limits. Pulmonary function tests and flexible bronchoscopy results were unremarkable. Her medical history revealed that a coil was inserted into the left ovarian vein via the right femoral vein three years ago due to pelvic congestion. The patient had no respiratory complaints during this period and continued her gynecological controls. Thoracic computed tomography (CT) performed to confirm the diagnosis was reported as incidental coil in the vascular structure in the right lung middle lobe lateral segment localization ( Figure 2). A conservative follow-up decision was made for the coil in the patient who had no clinical complaints and respiratory restriction. Written informed consent was obtained from patient.

Figure 1: Coil-shaped foreign body in the right middle zone on X-ray.

Figure 2: Computed tomography image of foreign body.

Causes of NTPE include fat, malignancies, infection, amniotic fluid and foreign bodies.[1, 4] Although there are various reports on foreign bodies in the literature, it is extremely rare for coils placed in ovarian veins to displace and cause embolism in pulmonary vascular structures. There are only two reported cases in the literature; one of the patients applied to the emergency department with acute embolism had a coil placed in the ovarian vein two weeks ago,[3] and the other,[4] similar to our case, the diagnosis was made when the ovarian coil placed 15 years before the clinical picture occurred was displaced and seen on the chest radiograph. In both the patient with acute embolism and the patient without clinical symptoms, a decision was made to follow without surgical intervention.

Foreign bodies seen in the lung radiologically can also be in pulmonary vascular structures other than the bronchial system. Non-thrombotic pulmonary embolism can cause a serious life-threatening clinical picture or it can be asymptomatic. Thoracic CT is the gold standard for the differential diagnosis of NTPE and the treatment should be determined according to the clinical condition of the patient. In asymptomatic patients, a decision to follow-up without intervention may be made.

Data Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Author Contributions: All authors contributed equally to this article.

Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding: The authors received no financial support for the research and/or authorship of this article.

References

1) Unal E, Balci S, Atceken Z, Akpinar E, Ariyurek OM. Nonthrombotic pulmonary artery embolism: Imaging findings and review of the literature. AJR 2017;208:505?16 doi: 10.2214/AJR.16.17326.

2) Montagnana M, Cervellin G, Franchini M, Lippi G. Pathophysiology, clinics and diagnostics of non-thrombotic pulmonary embolism. J Thromb Thrombolysis 2011;31:436-44. doi: 10.1007/s11239-010-0519-8.

3) León FX, Alba B, Arribas A, García R, García I, Quezada C A rare case of pulmonary embolism due to endovascular coil embolization and review of literature . Int J Respir Pulm Med 2018;5:094. doi: 10.23937/2378-3516/1410094.

4) D'Amato R, Figueira Gonçalves JM, Palmero Tejera JM. Pulmonary embolism due to metal coil migration after treatment of pelvic varices. Arch Bronconeumol 2017;53:72. doi: 10.1016/j.arbres.2016.03.012.