Presence Of Metallic Foreign Body Research Articles

High Output Heart Failure Secondary to Aorto-Caval Fistula Treated With an Amplatzer Septal Occluder: Case Report and Review of Literature

Aorto-caval fistula (ACF) is a rare cause of high output heart failure (HOHF). 80 % of cases are due to ruptured abdominal aortic aneurysm, while 10 to 20% are traumatic or congenital. Early diagnosis and treatment are crucial in order to prevent the progression to HOHF. Open surgical repair has been the mainstay therapy of arterio-venous fistulas including aorto-caval fistula; however endovascular approach has become an evolving therapeutic option in the last 20 years. Here, we present a case of high output heart failure secondary to traumatic aorto-caval fistula due to shrapnel injury to the abdomen. Our patient was managed with endovascular approach by the deployment of amplatzer septal occluder that excluded completely the fistula, resulting in the progressive improvement of HOHF. In this manuscript, we review etiologies of high output heart failure and summarize cases of aorto-caval fistula treated with amplatzer septal occluder reported in literature. We also highlight the importance of this endovascular device in the presence of metallic foreign body in the aorta.

Post-mortem analysis of gunshot wounds to the head and thorax in dogs by computed tomography, radiography and forensic necropsy.

In view of the scarcity of literature data on the use of radiological imaging techniques in forensic veterinary medicine, while at the same time the number of reported crimes against animals involving the use of firearms is rising, this paper attempts to assess the usefulness of radiography and computed tomography (CT) in the post-mortem diagnosis of gunshot wounds (GSW) in comparison to classic necropsy. The design of the experiment was as follows: preparation of the research material (13 dog carcasses), shooting of the material from different distances (1.5 and 12 m, plus one contact shot to the head) and using different types of ammunition, followed by X-rays and CT scans in each case to examine the injuries resulting from the shot. The final steps of the experiment were photographic documentation and autopsy by the Virchow method. In the examined material, post-traumatic bone lesions and the presence of metallic foreign bodies were successfully imaged by both radiography and CT. GSW analysis using CT provided much better data quality and some additional information. Two general conclusions can be drawn from the results of the experiment. First, damage caused by gunshots is correlated with the calibre, initial velocity and kinetic energy of the projectile, as well as the distance from the muzzle of the gun to the object shot. Second, radiological examination is useful in preparing forensic veterinary opinions. Used as a complement to classic necropsy, they increase the possibility of an accurate post-mortem diagnosis of shooting victims.

Contraindications and adverse effects in abdominal imaging.

Ultrasound (US), computed-tomography (CT) and magnetic resonance imaging (MRI) are the most frequently used imaging techniques in abdominal pathology. US plays a pivotal role in evaluating abdominal disease, sometimes being sufficient for a complete diagnosis and has virtually no contraindications. The usage of US contrast agents will add useful diagnostic information in both hepatic and non-hepatic pathology. CT has, over MRI, the advantage of being readily available. The usage of ionizing radiation is the main pitfall of CT. Allergies and contrast induced nephropathy in patients with an impaired renal function are the major risks of contrast media administration in CT. Its excellent tissue resolution makes MRI a very useful technique in abdominal pathology, the major contraindications being the presence of MRI "unsafe" implants and devices and the presence of metallic foreign bodies, particularly close to vital structures like the eyes or major vessels. Contrast administration in MRI is restricted in patients with renal insufficiency due to the risk of nephrogenic systemic fibrosis. Allergies to MRI contrast media are rare and less important compared to allergies due to CT contrast media.

Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children.

Coins are the most common ingested metallic foreign bodies among children. The goal of this protocol is to assess the accuracy and feasibility of using a handheld metal detector to detect ingested metallic foreign bodies in children. We propose that by introducing handheld metal detector screening early in the triage process of children with high suspicion of metallic foreign body ingestion, the number of radiographs being ordered to localize the metallic foreign body can be reduced in this radio-sensitive population. The study protocol requires the screening of the participants for history of foreign body ingestion and exclusion of patients with respiratory distress or metallic implants. The patient changes to hospital gown and items that could contain metal like eyeglasses, earrings, pendants, and ornaments are removed. The patient is positioned in the center of the room away from other metallic interferences. The working status of the handheld metal detector is first confirmed by eliciting a positive audio-visual signal. Then the screening is done in an erect position with head in extension to expose the neck, from the level of the chin to the level of the hip joint, to cover the anatomical areas from neck to pelvis in a zig-zag manner both anteriorly and posteriorly. A positive audio-visual signal is carefully noted during the scanning for the presence of metallic foreign body. Relevant radiographs are ordered as per the area detected on the metal detector screening. The handheld metal detector was able to precisely identify all the coins among the ingested metallic foreign bodies in our study. The handheld metal detector could not consistently detect non-coin metallic foreign bodies. This protocol demonstrates the accuracy of handheld metal detector in the identification and localization of coins and coin like metallic foreign bodies.

Applications under Сontrol Minimally Invasive Surgery Computed Tomography in Patients with Suppurative Lung Disease

Актуальность Ранняя диагностика нагноительных заболеваний лёгких во многом предрешает прогноз и результат лечения. Тяжесть состояния больных, необходимость в срочных лечебных мероприятиях, трудность их обследования требуют постоянного совершенствования методов диагностики и лечения. Наиболее распространенным методом диагностики нагноительных заболеваний легких является рентгенологическое исследование грудной клетки. По наблюдениям специалистов, данная методика позволяет диагностировать патологию грудной полости, но установить распространенность и стадию воспалительного процесса на основании полученных результатов не представляется возможным. В последнее время в литературе значительное внимание уделяется использованию магнитно-резонансной томографии (МРТ) в диагностике нагноительных заболеваний лёгких. Вместе с тем остается открытым вопрос о длительности исследования,трудностях в обеспечении контроля за состоянием пациента, особенно при ИВЛ, необходимости синхронизации с дыханием и сердечной деятельностью. В связи с этим, проведение МРТ при нагноительных заболеваниях лёгких является затруднительным. Кроме того, наличие инородных металлических тел является противопоказанием к проведению МРТ.Цель исследования Провести анализ эффективности использования малоинвазивных вмешательств под контролем компьютерной томографии у пациентов с нагноительными заболеваниями лёгких. Материалы и методы На основании данных сканирования уточнялись показания к вмешательству и определялся безопасный доступ к патологическому очагу. Затем производилось поэтапное введение в патологический очаг трансдермального дренажа с дальнейшим забором материала для цитологического и бактериологического исследований. Результаты и их обсуждение Широкое внедрение в повседневную практику компьютерной томографии позволило решить целый ряд лечебно-диагностических задач в хирургическом стационаре. Компьютерная томография к настоящему времени позволила значительно ускорить поиск нагноительной патологии лёгких, уточнить локализацию гнойного процесса и его отношение к другим анатомическим структурам. Способствовала более ранней активизации и сокращению сроков пребывания пациентов в стационаре.Заключение При анализе полученных данных установлено значительное снижение частоты послеоперационных осложнений, отсутствие болевого синдрома, происходила более ранняя активация и реабилитация пациентов.

Zinkintoxikation bei einem Yorkshire Terrier nach Aufnahme von Euro-Cent-Münzen

A 5-year old, intact male Yorkshire Terrier was presented due to lethargy, vomiting and diarrhea. Clinical signs included shock, icterus and a painful abdomen. Laboratory examination revealed a severe intravascular hemolytic anemia, a thrombocytopenia and a leukocytosis. The radiographic examination revealed the presence of metallic foreign bodies in the stomach and in the intestine. After stabilisation of the patient with crystalloids, packed red blood cells, ranitidine, metamizole, amoxicilline/clavulanic acid and marbofloxacine, surgery was performed and 5 coins (10 cent, 5 cent, 2 cent) were removed via esophagus and via enterotomy. In the course of disease the dog developed acute renal failure and pancreatitis. The zinc concentration in the serum was 2200 microg/dl, which was 30 times higher compared to a healthy control dog. After 21 days the dog was discharged from the hospital. On day 28 all laboratory values were within the reference range.

Delayed Intracerebral Hemorrhage From an Extracranial Ball Bullet Pellet

The evaluation of superficial penetrating injuries to the face and scalp is common in the emergency department. We present a patient who presented with a ball bullet pellet to the forehead with an initially negative computerized tomographic (CT) scan of the head, who represented 18 hours later with nausea, vomiting, and mental status changes. A repeat CT scan of the head revealed intraparenchymal hemorrhage immediately posterior to the site of pellet entry. Upon review, the initial CT scan was limited by scatter artifact. In this case report, we discuss the potential for significant injury with compressed air-driven arms, the limitation of CT in the presence of metallic foreign bodies, and the significant risks associated with pediatric radiation exposure.

Magnetic resonance angiography for anterior midline aneurysms.

Over an 18-month period (June 1993-December 1994), all patients presenting with a subarachnoid haemorrhage (SAH) were considered for magnetic resonance angiography (MRA) as part of their investigation. Our experience to date leads us to believe that anterior midline aneurysms can be confidently and rapidly diagnosed with MRA alone without recourse to invasive intra-arterial digital subtraction angiography. This assumes, of course, that images can be obtained; some patients cannot be investigated by MR because of the presence of metallic foreign bodies; in a small proportion without anaesthesia the images will be so degraded as to be valueless and some patients will be judged unsuitable from the outset because of their clinical state. In 30 patients, a diagnosis of an anterior midline aneurysm was made on MRA and 21 of these patients underwent surgery on the MR images alone. Surgery, undertaken via a midline approach in these 21 patients, confirmed the MR findings.

Metallic ballistic fragments: MR imaging safety and artifacts.

The ferromagnetism of various bullets and shotgun pellets was tested in vitro. Magnetic deflection showed that four of 21 metallic specimens tested (all bullets) demonstrated marked ferromagnetism. Three of these four were made outside the United States; two of the four were known to contain steel, and the other two were reportedly either copper or copper-nickel-jacketed lead bullets (indicating that the ferromagnetism was due to impurities in the bullet jackets or cores). Ferromagnetic bullets readily rotated within a gelatin phantom in response to magnetic torque. Nonferromagnetic bullets and pellets demonstrated only mild to moderate metal artifact during spin-echo and gradient-echo magnetic resonance (MR) imaging. However, all four of the ferromagnetic bullets produced severe MR artifacts and image distortion. MR studies of seven patients with retained bullets, pellets, or shrapnel were reviewed. In six of the seven, only mild MR artifacts were seen. Only intracranial shrapnel (presumably steel) in one patient created significant artifact. All seven patients with retained bullets and shotgun pellets were imaged safely with MR. However, caution should be exercised with MR imaging in the presence of metallic foreign bodies, particularly if they are located near vital neural, vascular, or soft-tissue structures.

Metallic ballistic fragments: MR imaging safety and artifacts.

The ferromagnetism of various bullets and shotgun pellets was tested in vitro. Magnetic deflection showed that four of 21 metallic specimens tested (all bullets) demonstrated marked ferromagnetism. Three of these four were made outside the United States; two of the four were known to contain steel, and the other two were reportedly either copper or copper-nickel-jacketed lead bullets (indicating that the ferromagnetism was due to impurities in the bullet jackets or cores). Ferromagnetic bullets readily rotated within a gelatin phantom in response to magnetic torque. Nonferromagnetic bullets and pellets demonstrated only mild to moderate metal artifact during spin-echo and gradient-echo magnetic resonance (MR) imaging. However, all four of the ferromagnetic bullets produced severe MR artifacts and image distortion. MR studies of seven patients with retained bullets, pellets, or shrapnel were reviewed. In six of the seven, only mild MR artifacts were seen. Only intracranial shrapnel (presumably steel) in one patient created significant artifact. All seven patients with retained bullets and shotgun pellets were imaged safely with MR. However, caution should be exercised with MR imaging in the presence of metallic foreign bodies, particularly if they are located near vital neural, vascular, or soft-tissue structures.