Radiologic evaluation of retained intrauterine contraceptive device (IUD) or a missing IUD thread-case report with discussion

Document Type

Conference Proceeding

Publication Date

11-27-2025

Abstract

Problem Statement: Intrauterine device (IUD) is a highly effective method of long term contraception. It is available in a a variety of forms including hormonal and non-hormonal (copper IUD) forms. While IUD insertion is quick and generally considered safe, when the IUD thread is missing it may be difficult to identify the hormonal IUDs compared with Copper-IUD. Radiological evaluation of missing IUD thread requires different imaging modalities to reach a definitive diagnosis and guide management. This case discusses different imaging modalities for missing IUD thread. Method: case reportinstitutional review board (IRB) exempt. Results: multiparous female with missing IUD that was seen within the endometrial cavity but patient unable to retrieve in the office. Conclusion: The copper containing IUD is hyperechoic and radiopaque while the hormonal IUD is only hyperechoic at the distal and proximal ends of the arms, but radiopaque due to the barium sulfate coating. Thus, in cases of suspected expulsion without witness of the expelled device, an endovaginal or pelvic ultrasound is recommended as well as x-rays to exclude perforation or migration.In cases of suspected perforation, displacement or embedment without identification of an IUD on ultrasonography, the next best step would be plain X-ray of the abdomen/pelvis as well. This allows for visualization of the Tshaped device, both hormonal and copper-containing. If the IUD is embedded within soft tissue it may be more difficult to see on x-rays. Ultimately, if there is perforation, fragmentation, or embedment, CT scans may be warranted for surgical planning and evaluation for complications such as abscess formation or bowel injury. In other countries, the material and shape of IUD may be different. In China, for instance, they use stainless steel ring IUD which will show up differently on imaging.

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33rd World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI): All about Women's Health, Rome Italy, November 27-29, 2025

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