What should be done if a bronze coil is embedded on the chest?

Management of Bronze Coil Embedded on Chest

If a bronze coil is embedded on the chest wall, it should be removed via intravascular retrieval using snares, as this approach is frequently successful for intravascular foreign bodies that have embolized to the pulmonary arteries or right heart. 1

Initial Assessment and Imaging

• Obtain immediate chest imaging to determine the exact location of the coil—whether it is superficially embedded in the chest wall soft tissues, within the thoracic cavity, or has embolized intravascularly 1

• CT scan is the gold standard for foreign body localization, with 90-100% sensitivity compared to only 32% for plain radiographs 2

  • CT will definitively identify the coil's exact location, assess for complications (vascular injury, perforation), and guide management 2
  • Plain radiographs have a false-negative rate up to 47% for foreign body detection 2

• Do not rely on negative plain films alone if clinical suspicion is high, as radiography can miss metallic objects entirely 2

Management Based on Location

If Intravascular (Pulmonary Arteries, Right Heart, or Vena Cava)

• Intravascular retrieval using snares is the treatment of choice and is frequently successful for coils and other endovascular foreign bodies 1

• This should be performed urgently by interventional radiology or cardiology with expertise in foreign body retrieval 1

• Most intravascular foreign bodies are found in the pulmonary arteries, with the remainder in the right heart or vena cava 1

If Superficially Embedded in Chest Wall Soft Tissue

• Surgical removal under local or general anesthesia is indicated to prevent migration, infection, or chronic foreign body reaction 3

• The procedure should be performed by a surgeon familiar with chest wall anatomy 3

If Penetrating the Chest Wall (Open Wound)

• This is a medical emergency requiring immediate activation of emergency response 1

• Do not place an occlusive dressing that could create tension pneumothorax; if a dressing is applied, monitor closely for worsening breathing and remove if symptoms deteriorate 1

• Surgical exploration and removal with assessment for pneumothorax, hemothorax, or cardiac injury is mandatory 1

Critical Pitfalls to Avoid

• Never assume the coil is superficial based on external appearance alone—it may have penetrated deeper structures or embolized intravascularly 1, 2

• Do not attempt blind removal without imaging confirmation of location and depth 2, 3

• Avoid contrast swallow studies as they increase aspiration risk and impair visualization if endoscopic or surgical intervention is needed 2

• Be aware that bronze/copper alloys can cause local tissue reaction and should not be left in place long-term 1

Special Considerations for MRI Safety

• Bronze coils are generally MRI-safe at 1.5T field strength, as most metallic clips, stents, and devices within the chest cause only local artifact without safety concerns 1

• However, verify the specific composition and MRI compatibility of the coil if known, as safety information should be consulted for specific implants 1

• Strict institutional safety procedures must be followed to prevent inadvertent approach to the magnet with ferromagnetic objects 1