Radiology Report Phrasing for Single Visualized Filshie Clip
When only one Filshie clip is visualized in the pelvis, state: "A single metallic tubal ligation clip is identified in the [right/left] adnexa. The contralateral clip is not visualized and may be absent, migrated, or obscured."
Recommended Report Structure
Your report should include these key elements:
- Specify laterality clearly: Document which side shows the clip (right or left adnexa)
- Acknowledge the missing clip explicitly: Don't leave it unmentioned, as this creates ambiguity
- Provide differential considerations: The absent clip could represent:
- Migration (occurs in approximately 25% of patients with Filshie clips) 1
- Technical factors (overlying bowel gas, body habitus limiting visualization)
- Prior removal
- Manufacturing/placement variation
Clinical Context and Pitfalls
Migration is more common than most clinicians realize. Studies show that 25% of Filshie clips migrate, though only 0.1-0.6% become symptomatic 1. Migrated clips have been found in diverse locations including the peritoneum, bladder, appendix, vagina, groin hernias, and even adjacent to the liver 1, 2, 3.
Key Reporting Considerations:
If the patient has chronic abdominal or pelvic pain: Explicitly suggest correlation with clinical symptoms and consider stating "migrated clip should be considered in the differential diagnosis" 1, 2
Search the entire abdomen/pelvis systematically: Don't limit your search to the adnexa. Review the upper abdomen, peritoneal cavity, and groin regions on available imaging 4
Document on plain radiographs when available: Filshie clips are radiopaque and well-visualized on X-ray, making them easier to track 4, 5
Avoid These Common Mistakes:
- Don't assume the missing clip is simply "not seen" without offering explanation
- Don't ignore a solitary clip as incidental—it may be clinically relevant
- Don't fail to review prior imaging if available to determine if both clips were previously present
The radiologist's accurate description of device position or absence directly impacts patient care and contraceptive counseling 4.