Pulmonary embolism of subdermal contraceptive implant: lung-sparing precision removal

Migration of subdermal contraceptive implants into the pulmonary vasculature is a rare but increasingly recognised complication. Optimal management remains unclear, with options including conservative monitoring, endovascular retrieval or surgery. We report the case of a woman in her late 20s with a non-palpable Nexplanon implant, found within a segmental branch of the right lower lobe pulmonary artery. Following multidisciplinary discussion and patient counselling, surgical removal was performed via a mini-thoracotomy after initial video-assisted thoracoscopic surgery exploration. A targeted lung-sparing incision enabled device retrieval without lung resection. The postoperative course was uneventful apart from transient issues with pain management, and the patient was discharged on postoperative day 5. This case highlights a precision surgical approach to remove a pulmonary artery-embedded contraceptive implant without sacrificing lung parenchyma. It underscores the importance of shared decision-making and a tailored, multidisciplinary approach in managing rare device-related complications.