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A woman aged 26 years was referred to interventional radiology for removal of an impalpable contraceptive implant (Implanon NXT) device. The device had been inserted three years prior by a general practitioner (GP), and the patient recalled that it was palpable immediately after insertion. The interventional radiology team did not have access to the GP’s notes to confirm this. The patient noticed soon after the insertion that the implant became no longer palpable. The patient’s body mass index was in the normal range at 21.3 kg/m2 and had remained stable over the past three years. There was no trauma to the arm in this time. While initially having complete cessation of menses as a resut of insertion of the device, two years post-insertion the patient had return of menses and wished to explore alternative contraceptive methods. At this time, the patient was referred to a gynaecologist. After contact with the gynaecologist, alternative oral contraception was arranged; however, it was decided that the Implanon NXT be left in place. As the patient recalls, the Implanon NXT was not palpable at the gynaecology outpatient consultation. The interventional radiology team did not have access to notes from this outpatient clinic. The patient recalled that three years post-insertion, she presented to the same GP as she wished to have the Implanon NXT removed, at which point she was referred to a gynaecology unit at a tertiary hospital for ultrasound-guided removal of the Implanon NXT. Initial ultrasonography of the left arm to locate the impalpable Implanon NXT did not find the device. Given concerns that the device may have embolised, a chest radiograph was performed and, given suspicion for identification in the lung, computed tomography (CT) of the chest was arranged. This showed that the device had migrated through the venous system and was lodged in a third-order pulmonary artery in a longitudinal orientation (Figure 1A), with the distal end in the lung parenchyma (Figure 1B). There was no pulmonary infarction, consolidation, ground glass density to suggest haemorrhage or any other pulmonary complication (Figure 2). Following identification of the device in the lung, the patient was referred to a dedicated interventional radiology outpatient consulting clinic for an opinion on removal of the device.

Implanon NXT embolisation into the pulmonary arterial tree