Migration of contraceptive implant

Case contributed by Dr Patrick Baird-Fraser

Presentation

Arrived for removal of contraceptive implant but unable to palpate it in the upper arm.

Patient Data

Age: 50 years
Gender: Female

No radio-opaque contraceptive implant seen within the soft tissues of the left upper arm. 4-cm linear density projected over the left lower zone on the frontal CXR. Lateral CXR confirms linear density lies within the left lower lobe. Findings in keeping with a migrated contraceptive implant

Case Discussion

Contraceptive implant migration is a rare complication of contraceptive implant insertion. The exact mechanism of this complication is unclear but is thought to be due to inadvertent venous insertion at time of initial procedure with embolization of the device via the right heart into the pulmonary arterial system. Case reports of endovascular retrieval have mixed success rates due to endothelialisation/fibrosis of the implant if left for a long period. Alternative is for a thoracotomy and segmentectomy. In the majority of case reports, the implant has been left in situ and the patient followed up, especially if the patient is asymptomatic and does not currently wish to conceive, as was the case with this patient. 

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