Sam Rowlands1, Diana Mansour2, Martyn Walling3. 1. The Junction, 235 Holdenhurst Road, Bournemouth, BH8 8DD, UK; Centre of Postgraduate Medical Research and Education, Faculty of Health and Social Sciences, Bournemouth University, R506 Royal London House, Christchurch Road, Bournemouth BH1 3LT, UK. Electronic address: srowlands@bournemouth.ac.uk. 2. New Croft Centre, Market Street (East), Newcastle upon Tyne, NE1 6ND, UK. Electronic address: diana.mansour@nuth.nhs.uk. 3. Kingsley-Ward Centre, 42-82 Southchurch Road, Southend-on-Sea, SS1 2LZ, UK. Electronic address: martyn.belmontdoc@sky.com.
Abstract
CASES: In addition to previously published case reports, further cases of intravascular migration of contraceptive implants have been identified from an information request to two national adverse reaction spontaneous reporting systems. We report on two new cases of insertion into the venous system with subsequent embolism to a pulmonary artery. CONCLUSION: Incorporating barium sulfate into the implant has facilitated diagnosis of these very rare adverse events with the initial diagnosis of embolism to the pulmonary arterial tree made by chest X-ray. Removal of an implant from a segmental branch of a pulmonary artery is technically challenging and not without risks. Unsuccessful removal appears to be preceded by a delay in diagnosis leading to endothelialization of the implant in the pulmonary arterial wall. IMPLICATIONS: Subdermal placement of contraceptive implants over the anterior surface of the biceps rather than in the sulcus between the biceps and triceps may negate this rare but reported risk.
CASES: In addition to previously published case reports, further cases of intravascular migration of contraceptive implants have been identified from an information request to two national adverse reaction spontaneous reporting systems. We report on two new cases of insertion into the venous system with subsequent embolism to a pulmonary artery. CONCLUSION: Incorporating barium sulfate into the implant has facilitated diagnosis of these very rare adverse events with the initial diagnosis of embolism to the pulmonary arterial tree made by chest X-ray. Removal of an implant from a segmental branch of a pulmonary artery is technically challenging and not without risks. Unsuccessful removal appears to be preceded by a delay in diagnosis leading to endothelialization of the implant in the pulmonary arterial wall. IMPLICATIONS: Subdermal placement of contraceptive implants over the anterior surface of the biceps rather than in the sulcus between the biceps and triceps may negate this rare but reported risk.
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