Sonographic detection and localization of a clinically nondetectable subcutaneous contraceptive implant

Subdermal implantable contraceptive devices (SCDs), successfully used in clinical practice since 1974, consist of single or multiple rods that are surgically implanted at the level of the medial aspect of the arm. They contain levonorgestrel, which is slowly released into the systemic circulation, ensuring a constant blood level. Although effective, they cause side effects in approximately 80% of users, mainly related to the systemic pharmacologic action. Local complications are rare. Surgical removal is usually simple because the devices can be palpated. Occasionally an imaging modality is needed to accurately localize clinically nonpalpable implants. We report the case of a woman who previously underwent unsuccessful removal of a nonpalpable device. High-resolution sonography allowed accurate localization of the SCD and its easy removal.