LET’S TALK IUC - THREE TOO MANY! A CASE STUDY OF THREE COILS IN ONE PATIENT
Roopam Rabadia, London North West University Healthcare NHS Trust
Background:
Intrauterine contraception (IUC) is a popular and effective long-term reversible contraception method. Common complications include pain, lost threads, and irregular bleeding. Ultrasound is preferred for assessing IUCs due to its cost-effectiveness, reproducibility, and non-ionising radiation. Typically, an IUC should be centrally located in the endometrial cavity with the crossbar in the fundal region.
Case summary:
A 52-year-old female with elevated prolactin levels and a history of ovarian cysts underwent a diagnostic ultrasound. The ultrasound was challenging due to an anterior wall, central submucosal fibroid (FIGO 2), complicating the endometrial cavity assessment. Although the patient did not attend for coil assessment, a levonorgestrel (LNG) coil was noted.
Initial 3D ultrasound images suggested two, possibly three, coils, but their exact number and positioning were unclear. A pelvic radiograph confirmed the presence of three LNG IUC coils. A subsequent CT scan detailed their locations: one coil was correctly positioned within the uterine cavity, the second was predominantly in the endometrial cavity with the left arm embedded 12 mm into the posterior myometrium, and the third had its stem in the cervix and horizontal arms in the lower uterine cavity.
The multimodality imaging approach was vital for planning clinical management, as the coils’ placement and embedment influenced removal strategies. This case underscores the importance of teamwork in diagnostic imaging and the value of additional modalities like X-rays, CT, and MRI when ultrasound is insufficient due to anatomical or technical challenges. It also highlights the necessity of understanding the patient’s medical history and symptoms, following departmental policies, using structured report templates, and seeking second opinions as necessary. Adhering to guidelines from professional bodies like the Society and College of Radiographers (SCoR) and the British Medical Ultrasound Society (BMUS) ensures consistency in patient care. Collaboration with radiologists is also crucial for accurate assessment and optimal patient outcomes.