Systemic cardiac microcoil migration: A rare complication of CT-guided lung localization

CT-guided microcoil localization facilitates minimally invasive resection of small pulmonary nodules, but intravascular migration is rare and potentially serious. A 63-year-old man with treated classical Hodgkin lymphoma underwent localization of an FDG-avid right upper lobe semisolid nodule before planned video-assisted thoracoscopic resection. Cone-beam CT showed a 7.6 × 19.1 mm lesion 37.3 mm from the pleura. With the patient supine, a 0.7 mm × 5 cm Visicoil marker was deployed once through a 10 cm, 18-gauge coaxial needle positioned 2.7 mm from the lesion. No pleural anchoring was used, and vascular puncture was not recognized. Immediate fluoroscopy and cone-beam CT showed no coil at the target and a small tract hematoma; short-interval imaging demonstrated changing cardiac-vascular projections. The procedure was aborted. Echocardiography did not visualize the coil or show thrombus, valvular interaction, or new myocardial injury. Dedicated cardiac CT was interpreted as showing the coil along the inferior right ventricular wall, but the discordant earlier nongated images prevented reconstruction of a physiologic migration route. The asymptomatic patient had an unchanged coil projection on serial radiographs. Because retrieval risk was judged substantial, multidisciplinary consensus favored conservative management with temporary antithrombotic therapy. No migration-related symptoms were documented through 5 months. This case emphasizes immediate postdeployment confirmation, vascular-trajectory planning, definitive cardiac localization, and individualized assessment of retrieval versus observation.