A perforated IUD with copper seen on a sagittal view with transvaginal ultrasonography as a 2 cm hyperechoic (rendered as bright) line behind the uterus. The patient was a 67 year old woman who had it inserted 36 years earlier. It is now surrounded by a foreign body granuloma that is hypoechoic (dark). The urinary bladder is seen at bottom right (hypoechoic as well).