Intravascular migration of a subdermal etonogestrel implant to the pulmonary artery: A case report

Abstract

Pulmonary migration of subdermal etonogestrel implants is an exceedingly rare but potentially serious complication. Diagnosis is frequently delayed because patients are often asymptomatic and the implant is non-palpable at the insertion site. We report the case of a 22-year-old nulligravida woman presenting three years after implant insertion with a non-palpable etonogestrel device and multiple unsuccessful removal attempts. Ultrasound of the left upper arm and humeral radiographs were negative. Subsequent chest radiography demonstrated a linear radiodense structure projected over the left hilar region. Computed tomography pulmonary angiography confirmed intravascular migration of the implant, lodged within a subsegmental branch of the left inferior pulmonary artery. The patient remained asymptomatic and declined endovascular or surgical retrieval, opting for conservative management with clinical and imaging follow-up. This case highlights the importance of extending imaging beyond the insertion site in patients with non-palpable contraceptive implants and emphasizes the role of chest radiography and CT pulmonary angiography in accurately localizing migrated devices.