Localization of a contraceptive implant using a silicon chip-based handheld ultrasound device

Etonogestrel contraceptive implants (Implanon/Nexplanon) are a highly effective form of long-acting reversible contraception. Removal is typically straightforward when the implant is palpable in the upper arm. However, it can become challenging if the implant cannot be located by palpation due to deep placement, weight gain, or migration. Ultrasound is the recommended first-line imaging modality to localize non-palpable implants. Standard cart-based ultrasound devices may not be readily available in all settings (e.g., outpatient clinics, operating rooms, or resource-limited regions). A new generation of handheld ultrasound devices based on silicon chip technology has recently emerged, offering high-resolution imaging in a handheld, point-of-care format. These devices have the potential to facilitate rapid bedside localization of implants.

We present the first case of localizing a non-palpable Implanon NXT® (68 mg etonogestrel) rod using a silicon chip-based handheld ultrasound device (Butterfly iQ). A 27-year-old woman with a non-palpable upper arm implant underwent sequential scanning with the handheld ultrasound device connected to a smartphone and with a standard piezoelectric ultrasound device for comparison. The handheld ultrasound readily identified the implant as an echogenic focus in the arm, enabling marking of the location for removal. A confirmatory scan with a standard ultrasound unit likewise visualized the implant. Guided by these imaging findings, a small incision was made directly over the implant site and the rod was removed successfully under local anesthesia.

This case demonstrates that a semiconductor-based handheld ultrasound can reliably detect a non-palpable contraceptive implant, yielding sonographic images comparable to a standard piezoelectic ultrasound device. The successful localization and removal of the implant using the portable device suggests that this new ultrasound technology can be a valuable tool in obstetric and gynecologic practice for managing challenging implant cases. Its portability and ease of use at the point of care may improve access to timely implant removal in clinic settings, operating theaters, and remote or underserved areas. Wider adoption of this technology, alongside formal studies validating its accuracy, could enhance clinical workflows for contraceptive implant management.