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Lung migration of contraceptive Implanon NXT
  1. Mariana Carlos-Alves,
  2. Marina Gomes,
  3. Rita Abreu and
  4. Paula Pinheiro
  1. Gynaecology and Obstetrics, Unidade Local de Saúde do Alto Minho EPE, Viana do Castelo, Portugal
  1. Correspondence to Dr Mariana Carlos-Alves, mariana.fcarlosalves{at}gmail.com

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Description

The authors describe a case of Implanon NXT subcutaneous contraceptive device migration into the lung in a 31-year-old woman.

The patient had a healthy previous medical history. She had no previous surgeries and no relevant family history. Para 1, she had previous regular cycles and used Implanon NXT subcutaneous contraception for 8 years: the first Implanon NXT was placed in 2010 and replaced in 2013, the third was placed in 2017.

The patient was referred to our gynaecological consultation to remove the implant because she had abnormal uterine bleeding for 3 months. Examination of the patient’s arm failed to localise the implant. Ultrasound of the soft tissues was requested and revealed that ‘the subcutaneous implant is located in the left mammary groove or the left lateral costal wall’. Chest radiography (figure 1) showed that the implant was located in the lower lobe of the left lung and CT (figure 2) confirmed the implant was located in the lower lobe of the left lung, and it was difficult to establish its precise location (Intravascular? Intraparenchymal?); no pleural or pericardial effusion.

Figure 1

Chest X-ray showing implant location in the lower lobe of the left lung (arrow).

Figure 2

Chest CT scan confirming implant location in the lower lobe of the left lung.

The patient was sent to a reference Cardiothoracic Surgery Department where she underwent contrasted CT, which revealed a ‘hyperdense image with 40 mm, compatible with Implanon in the anterior basal segment of the lower left lobe in intravascular topography’. Implanon was removed by video assisted thoracoscopic surgery without pulmonary resection. Surgical procedure and postoperative course had no complications. The patient was discharged 4 days later. At the postoperative visit, she had no complaints and had normal operative wound healing; chest radiography was normal.

Migration of an Implanon to the lung is very rare, with few cases described in the literature.

Learning points

  • Implanon NXT is a subcutaneous contraceptive device consisting of a small plastic structure non-absorbable in the human body with about 4 cm long and 2 mm of diameter, containing 68 mg of etonogestrel. It has a small amount of barium sulfate in order to make it visible on X-ray.1

  • Implanon is usually placed about 8–10 cm above the elbow on the medial aspect of the non-dominant arm, avoiding the groove between the bicep and triceps muscles because of the large blood vessels and nerves.1

  • Risk factors for Implanon migration are placement technique (if introduced deeply migration can occur into the venous system and then to the pulmonary arterial system) and the practice of vigorous physical exercise after correct placement, which seems to increase the risk of vascular migration.1–3

  • In the case of a non-palpable Implanon, ultrasound of the soft parts should be requested and, if not visualised, the patient should undergo a chest radiography.3

References

Footnotes

  • Contributors MC-A and MG examined the patient. RA and PP sent the patient to a reference Cardiothoracic Surgery Department. All authors wrote the manuscript and approved it for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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