Subdermal contraceptive implant migration to the pulmonary vasculature: A case report

Subdermal implants are highly effective long-acting reversible contraceptives. Rarely, they may migrate intravascularly. This report concerns the case of a 22-year-old woman who presented for removal of a non-palpable etonogestrel implant. Imaging revealed migration to the pulmonary vasculature. Surgical consultation confirmed intravascular embolization to the basal anterior segmental artery of the left lower lobe. Extraction of the implant was performed without complications. Subdermal contraceptive implant embolization into the pulmonary vasculature is an emerging iatrogenic complication. The clinical relevance of this complication lies not only in its potential for pulmonary damage but also in its diagnostic challenge and management complexity. While endovascular retrieval should be considered the first-line approach, especially in cases detected early, in the present case this was not feasible due to endothelialization; thoracotomy ensured safe removal. Pulmonary migration of contraceptive implants is rare but potentially serious. Delayed diagnosis may preclude endovascular removal. • Migration of an etonogestrel implant insertion was detected incidentally by chest imaging four years after the procedure. • Computed tomography confirmed the implant had lodged in the basal anterior segmental artery of the left lower lobe. • Endovascular retrieval was not feasible due to endothelialization; thoracotomy ensured safe removal. • The patient recovered uneventfully with full pulmonary expansion and no postoperative complications. • This case highlights the need for provider training, early imaging of non-palpable implants, and multidisciplinary management.