Missing nexplanon

Case contributed by Dr Christina Fong

Presentation

G1P1001 patient with a history of Nexplanon placement in her left arm two years ago, who presented to the ED for Nexplanon removal, but they could not palpate the Nexplanon on exam

Patient Data

Age: 30 yo
Gender: Female
X-ray

A Nexplanon implant is in the soft tissues of the medial mid upper arm at a depth of approximately 3.3 cm from the skin and approximately 15 cm proximal to the elbow joint.​

Ultrasound

A Nexplanon can be seen as a linear echogenic shadowing structure measuring approximately 3.5 cm in length at a depth of 1.4 cm from the skin just beneath the subcutaneous tissues.

Case Discussion

A Nexplanon is generally palpable on clinical exam and no imaging is needed for localization. The implantation and removal are done without imaging guidance. 

In this patient, the Nexplanon could not be not palpated on exam and was identified on a radiograph of the humerus. Ultrasound was subsequently performed to facilitate easy removal. 

The nexplanon is radio-opaque and is easily visible on radiography. Given the lack of urgency, the patient decided to schedule a clinic appointment for Nexplanon removal, which typically occurs at three years.

 

This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center   

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Case information

rID: 63826
Published: 28th Oct 2018
Last edited: 28th Oct 2018
Inclusion in quiz mode: Included
Institution: UCLA

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