Migrated Contraceptive Implant Detected in Woman’s Lung

Key Takeaways

A woman in her late 3srcs presented with a complaint of not being able to palpate the subdermal contraceptive implant in her left arm, which was inserted 6 years earlier. An x-ray revealed a radiodensity above the left lower lobe, and a CT scan confirmed migration into a subsegmental artery.

As the patient was asymptomatic, she declined surgery. A 6-month follow-up CT scan revealed no further migration.

Tooba Kareem, a radiologist at the University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, England, reported this rare but significant complication of subdermal contraceptive implants.

The Patient and Her Medical History

The patient arrived at a hospital in Stoke-on-Trent, seeking medical attention after noticing that her contraceptive implant, which had been inserted subdermally in her left arm 6 years ago, was no longer palpable. She first noticed this change just a week after the implantation.

She did not report this, and no further investigations were undertaken at that time. The patient was asymptomatic and had no other complaints. Initially, she experienced irregular periods, but over time, her menstrual flow became lighter. Her cycles had normalised over the past 3 years.

Findings

The patient’s vital parameters, including oxygen saturation and respiratory rate, were within the normal range. Physical examination showed no abnormalities, but the implant in the left arm was no longer palpable. Laboratory tests revealed no abnormalities.

A posteroanterior chest x-ray revealed a linear radiodensity measuring approximately 3.4 cm in length projected over the left lower zone.

Initially suspected to be within the subcutaneous tissue, a left lateral chest x-ray was performed to confirm its location.

The lateral chest x-ray showed no radio-opaque density in the anterior or posterior soft tissues. It did indicate a subtle linear density anteriorly over the lower lung zones, which, in conjunction with the frontal chest x-ray, raised suspicion of implant migration into the left lung.

Diagnosis

CT imaging with intravenous contrast was performed. The contraceptive implant was found within the subsegmental artery of the anterobasal segment of the left lower lobe. No inflammatory changes were observed in the adjacent lung, and the rest of the scan was unremarkable.

The patient was counselled on the available treatment options and provided with detailed information regarding the benefits and risks of removing what was believed to be at least two anterior segments of the left lower lobe of the lung under general anaesthesia.

An endovascular procedure was not considered, as the implant migration had occurred 6 years earlier, and endothelialisation was expected. Given the absence of symptoms, the patient opted against surgery.

A follow-up CT scan performed 6 months later confirmed no further migration of the implant. She was advised to revisit the clinic immediately if symptoms such as haemoptysis or chest pain developed.

Discussion

The authors wrote that “Subdermal implants are considered safe and efficient contraceptive devices.”

Implant migration into the lungs is rare, with 1src7 cases reported globally between August 1998 and September 2src19. Pulmonary embolism from migration is even rarer. The risk factors include deep insertions and placement in thin arms. Prompt detection and documentation with x-ray and CT imaging are recommended.

This article was translated from Univadis Germany using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.