PMC6054767_01
(A) AP radiograph (X-ray) of the left upper arm (humerus and cubital fossa) with no evidence of visible radiopaque subcutaneous contraceptive implant. (B) AP radiograph (X-ray) of the chest. This was initially reported as normal, but closer assessment of the right mid-zone shows the radiopaque contraceptive implant which was initially incorrectly interpreted as a prominent bronchovascular marking given its relatively short, linear outline (black arrow). On subsequent appreciation by the radiologists of the short, tubular shape of the Nexplanon  implant, the foreign body was immediately identified. (C) Judkins right (JR4) catheter positioned in the right pulmonary artery with the contraceptive implant visualized on fluoroscopy (black arrow). (D) Selective pulmonary angiography confirms the intravascular placement of the foreign body (black arrow) in a branch of the right lower lobe pulmonary artery. (E, F) AP and lateral fluoroscopy views demonstrating the utilization of a gooseneck snare to extract the foreign body from the pulmonary artery (black arrows). A straight-ended Terumo (Terumo Corporation, Tokyo, Japan) guidewire was utilized for support. (G, H) Explanted device attached to a Judkins diagnostic (JR4) catheter and the device adjacent to a 5 mL syringe to demonstrate size.. Abbreviation: AP, anteroposterior,
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The implant was not palpable in the upper arm and unable to be localized by ultrasound or X-ray of the arm (Figure 1A). Chest X-ray (CXR) was undertaken and was reported normal by local radiologists (Figure 1B). The procedure was undertaken in the cardiac catheter laboratory under local anesthesia from the right femoral vein using biplane angiography (Figure 1C and D). A coaxial approach was used to introduce a series of catheters into the right pulmonary artery which facilitated the capture of the device using a gooseneck snare allowing subsequent extraction of the intact device (Figure 1E-H).