Imaging Findings in the Diagnosis and Management of Misplaced IUDs

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Journal of Ultrasound in Medicine

Abstract

Objectives: Intrauterine devices (IUDs) are a common contraceptive choice, but complications such as migration or abnormal placement can reduce their effectiveness and pose risks to the patient. This presentation focuses on the radiologic identification of misplaced IUDs, highlighting key imaging modalities that assist in determining IUD position, identifying abnormal placements, and guiding subsequent decision-making. Methods: This presentation reviews the case of a 33-year-old G3P2 patient with a migrated Paraguard IUD. We analyzed the imaging findings using ultrasound and reviewed the literature on the radiologic evaluation of IUDs, focusing on normal versus abnormal placement, key imaging signs, and the role of advanced techniques such as 3D ultrasound, x-ray, and CT. Results: Ultrasound Imaging: In this case, transvaginal ultrasound was utilized as the first-line imaging tool. It revealed a linear echogenic structure in the endometrial canal, consistent with the IUD’s arms. The T-shaped configuration of the IUD was visualized, confirming its presence. While the IUD was in the endometrial cavity, the abnormal orientation of the IUD indicated partial embedding into the myometrium, suggesting improper positioning. • Abnormal Positioning and Imaging Indicators: The abnormal orientation and partial embedding of the IUD were critical findings. On imaging,  malpositioned IUDs can present as: o Partial or full embed-ding into the myometrium or adjacent structures such as the cervix, seen as echogenic structures on ultrasound outside of the typical endometrial cavity. o Migration into the abdominal cavity, which would require an x-ray or CT scan to visualize the IUD in extrapelvic locations. o Perforation of the uterine wall, where the IUD may appear distorted or displaced outside the uterine cavity on ultrasound or x-ray. • Additional Imaging Modalities: o 3D Ultrasound can be employed to obtain clearer, multiplanar images of IUD positioning within the uterus, particularly in cases where standard 2D ultrasound is inconclusive. This modality helps in confirming the depth and degree of embedding into the myometrium. o x-ray Imaging may be used if the IUD cannot be localized via ultrasound. Upright anteroposterior and lateral x-rays can help confirm if the IUD has migrated into the abdominal or pelvic cavity. o CT Scan or MRI can be considered in rare cases of severe migration, particularly if perforation into adjacent organs such as the bladder or bowel is suspected. Conclusions: The correct positioning of an IUD is crucial to its efficacy, and imaging plays an essential role in con-firming proper placement or identifying mispositioned devices. Ultrasound, particularly transvaginal, remains the first-line imaging modality for evaluating IUD placement, with key indicators of abnormal placement being improper orientation, embedding into the myometrium, or migration outside the endometrial cavity. For more complex cases, 3D ultra-sound, x-ray, or CT scans can offer further insights into the IUD’s location, particularly in cases of uterine perforation or migration to the abdominal cavity. Radiologists must be aware to the subtle signs of IUD displacement and abnormal positioning on imaging to guide appropriate management steps and prevent complications. Understanding the imaging characteristics of properly placed versus mispositioned IUDs is key to ensuring patient safety and the effective use of IUDs as a contraceptive method.

Volume

44

Issue

S1

First Page

S124

Comments

2025 American Institute of Ultrasound in Medicine (AIUM) Annual Convention, March 29 - April 1, 2025, Orlando, FL

Last Page

S125

DOI

10.1002/jum.175_70067

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