Nexplanon migration into a subsegmental branch of the pulmonary artery: A case report and review of the literature

• Published in: Medicine (Baltimore) Vol. 99; no. 4; p. e18881
• Main Authors: Hindy, Joya-Rita, Souaid, Tarek, Larus, Corinne Tuckey, Glanville, Joanne, Aboujaoude, Ramzi
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.01.2020
• Subjects: Adult; Clinical Case Report; Computed Tomography Angiography - methods; Contraceptive Agents, Hormonal - administration & dosage; Desogestrel - administration & dosage; Drug Implants - adverse effects; Female; Foreign-Body Migration - diagnostic imaging; Foreign-Body Migration - surgery; Humans; Pulmonary Artery - diagnostic imaging; Ultrasonography
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000018881

Nexplanon is a 4 cm rod-shaped barium sulphate coated contraceptive implant with a usual subdermal insertion in the inner non-dominant upper arm. Complications proper to subdermal contraceptive implants are unusual and principally localized and minor, comprising infection at the site of implantation, hematoma, abnormal scar development, or local nerve and blood vessel injuries. Infrequently, contraceptive implant migration can happen, though habitually not far from the site of insertion. Pulmonary embolization of the device is remarkably rare and can present with symptoms such as chest pain or dyspnea. We report one of the rare cases of asymptomatic Nexplanon pulmonary embolism in a 26-year-old female. An endovascular intervention successfully retrieved the device from the lateral segment right middle lobe pulmonary artery without any complications. Several cases of contraceptive implant migration into the pulmonary artery have been reported to this day. Preventing this life-threatening complication is challenging, and yet, no clear guidelines have been established.