title: Intravascular migration of contraceptive implants: two more cases.
abstract: METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Sam
authors.initials: S
authors.lastname: Rowlands
authors.affiliation: New Croft Centre, Market Street (East), Newcastle upon Tyne, NE1 6ND, UK. Electronic address: diana.mansour@nuth.nhs.uk.
authors.forename: Diana
authors.initials: D
authors.lastname: Mansour
authors.affiliation: Kingsley-Ward Centre, 42-82 Southchurch Road, Southend-on-Sea, SS1 2LZ, UK. Electronic address: martyn.belmontdoc@sky.com.
authors.forename: Martyn
authors.initials: M
authors.lastname: Walling
mesh_terms: D001132:Arm; D001466:Barium Sulfate / Q000008:administration & dosage; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003287:Contrast Media; D017135:Desogestrel / Q000008:administration & dosage; D004343:Drug Implants / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D011651:Pulmonary Artery; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D006113:United Kingdom
chemical_list: D003271:Contraceptive Agents, Female; D003287:Contrast Media; D004343:Drug Implants; D001466:Barium Sulfate; C044815:etonogestrel; D017135:Desogestrel
keywords: Contraceptive implant; Intravascular; Lung; Pulmonary artery; Pulmonary embolism