Radiopaque Foreign Body Research Articles

Body Packing and Its Radiologic Manifestations: A Review Article

Body packing is described as using the abdominal or pelvic cavity for concealing illegal drugs. Leakage from the packets may cause catastrophic effects on smugglers and medical history is not reliable in these patients. Moreover, new sophisticated smuggling techniques make it imperative that radiologists and emergency physicians understand and familiarize themselves with the different radiological manifestations of ingested drug packets. Currently, there is no gold standard for imaging patients suspected of body packing; nevertheless, computed tomography (CT) seems to be the best modality for packet detection and unenhanced CT without bowel preparation is a reliable technique for detection of ingested packets. On abdominal radiography, packets may be visualized as oval or round radiopaque foreign bodies surrounded by a gas halo. In the literature, sensitivity of abdominal radiography is reported from 74% to 100%. Visualization of the drug packets may be strikingly hampered by administration of oral or intravenous contrast medium in abdomino-pelvic CT; hence, contrast-enhanced CT does not seem to be a suitable modality for searching the ingested packets in suspicious smugglers.

Diagnostic value of various investigations in children with suspected foreign body aspiration

Foreign body aspiration is a serious condition during childhood that requires prompt management to avoid complications and irreversible lung injury. Rigid bronchoscopy under general anaesthesia is the procedure of choice for removal of aspirated foreign bodies, but it can be associated with serious complications. The positive diagnosis can sometimes be challenging except in the case of radiopaque or obstructive foreign bodies, due to the low sensitivity and specificity of clinical history and physical examination. The aim of this review is to evaluate the various investigations in children with suspected foreign body aspiration, in order to reduce the negative rigid bronchoscopy rate. Review of the literature based on Medline data between 1980 and 2010. Chest radiography during inspiration and expiration, often performed as the first-line radiographic investigation, has a low sensitivity and specificity. In the absence of a radiopaque foreign body, obstructive emphysema is the most specific radiographic sign. Airway fluoroscopy can complete chest radiography when radiographic signs are nonspecific. Flexible bronchoscopy is the most sensitive and most specific examination, but is not always available, as it must be performed in the operating room or with resuscitation equipment at hand. This procedure should be performed when foreign body aspiration is suspected in the absence of typical clinical and radiological signs. It can decrease the number of negative rigid bronchoscopies. Several studies suggest that chest CT is also a very sensitive examination in this indication. The sensitivity and specificity of chest CT for the diagnosis of bronchial foreign body must be validated by a prospective study. A national multicentre study is currently underway to determine whether CT can replace flexible bronchoscopy when the diagnosis of bronchial foreign body is uncertain.

Deliberate Underexposure in Cases of Radiography of Suspected Ingested Highly Visible Foreign Bodies—A Preliminary Study

Introduction Because of the linear response of digital detectors, it was hypothesized that large radiopaque foreign bodies would remain visible even when the image is grossly underexposed, meaning that dose could be greatly reduced without compromising diagnostic usefulness of the image. Methods Several metallic objects were placed over the abdominal area of an adult anthropomorphic phantom and imaged at different exposure levels ranging from 16.8 milliampere-seconds (mAs) to 0.5 mAs at a film-focus distance of 170 cm. The resulting images were subjectively scored for ease of visualization of anatomical features and metallic objects. In addition, the detection performance of three observers was assessed for the images obtained at 0.5, 1.25, and 2.5 mAs. Results All foreign bodies could be detected, even at the lowest exposure level. One observer failed to detect a screw projected over the spine at the lowest exposure setting. Conclusion The findings suggest that in cases where radiography is used to detect a large radiopaque object, the normal exposure may be reduced by around 70%, although further research using patients should be conducted before firm conclusions can be reached.

Foreign Body in Preauricular Region

Foreign bodies, although they are often found throughout the body, to a lesser degree in the face, still constitute a diagnostic challenge for the trauma surgeon. Its removal means danger of damaging important facial anatomic structures, even if its exact position from the image data was known. So, the objective is to describe a clinical report of a patient (42 years of age, male sex) who experienced falling to the ground, attended by the Department of Surgery and Traumatology Bucco-Maxillo-Facial Surgery, Faculty of Dentistry of Araçatuba, São Paulo State University, and 2 days after the trauma, he reported difficulty in mouth opening and pain. After clinical evaluation, we observed the presence of injury in the left preauricular region already in the process of healing. During the intraoral physical examination, a limitation of the mouth opening was noted. Radiographic posteroanterior and profile of the face showed 2 radiopaque foreign bodies in the left side, lying apparently at the region of the mandibular condylar process. Under local anesthesia, foreign body removal was carried from there with access to it through the preexisting facial injury. Further clinical examinations showed an improvement in mouth opening, absence of pain complaints, and/or functional complaints.

An Interesting Reason for Chronic Sinusitis

Various kinds of etiological factors play a role in chronic sinusitis, and foreign bodies in the sinuses are one of the etiological factors. A 44-year-old man attended our outpatient clinic with complaints of headache, nasal congestion, and postnasal drainage. He had a history of gunshot accident 1 year ago, and his paranasal computed tomography revealed a bullet-shaped, radiopaque foreign body in the right maxillary sinus floor. With the patient under general anesthesia, the foreign body was removed endoscopically. One year after the surgical removal, the patient became free of nasal symptoms.

Imaging diagnosis of gastrointestinal foreign bodies in dogs and cats: Part 2

Gastrointestinal foreign bodies are an important differential diagnosis for patients presented for vomiting, and radiography remains the main initial imaging modality in these cases. However, while the detection of radiopaque foreign bodies is usually easy, radiolucent foreign bodies are more difficult to identify. This is particularly true if the obstruction they cause is incomplete or very proximal in the gastrointestinal tract, or if a linear foreign body is present. In these cases, ultrasonography can be a very useful complementary imaging technique. This article describes common radiographic and ultrasonographic changes associated with gastrointestinal foreign bodies.

Distal airway foreign bodies: Importance of a stepwise approach, knowledge of equipment and utilization of other services’ expertise

Many distal airway foreign bodies present as obstructive atelectasis and may be removed using instruments passed through rigid bronchoscopes. Deeply impacted distal foreign bodies remain problematic and sometimes require thoracotomy. The purpose of this paper is to discuss alternate approaches to avoid open surgical removal. A clinical algorithm is outlined. A young child presented to the hospital with an episode of coughing and oxygen desaturation. A chest radiograph demonstrated a radiopaque foreign body in the right upper lobe with distal atelectasis. The foreign body could not be found using rigid bronchoscopy so a flexible bronchoscope (3.5 mm) was used to identify the distal primary tooth that was lodged in the inflamed tertiary segment of the bronchus. The tooth could not be removed using instruments passed through the sideport of the bronchoscope including balloon catheters, ureteral baskets, and biopsy forceps. The catheters were too compliant to reach the upper lobe and the forceps could not engage the tooth. A decision was made to treat the child with steroids and attempt removal 48 h later. The inflammation had resolved and the tooth had shifted positions to a more accessible left lower lobe tertiary segment. Using fluoroscopy with guide wires through the endotracheal tube, the tooth was removed. Tools used by different services are available as well to retrieve foreign bodies and may obviate the need for thoracotomy. Steroids decreased swelling allowing better access to the foreign body.

C-arm fluoroscopy for the removal of an intraorbital foreign body in a cat

This report describes the clinical manifestations, diagnosis and minimally surgical intervention of a cat with an intraorbital foreign body. A spayed female cat of unknown age was presented with a recurrent cutaneous sinus tract of the left suborbital region. The cat had not vocalized at all since the adoption. A sharp-edged radiopaque foreign body was visualized on dental radiography. Computed tomography outlined the length of the foreign body from the intraorbital soft tissue to the pharynx. The foreign body was removed under the guide of C-arm fluoroscope with minimal skin incision. The surgical site healed completely on the 11th postoperative day, and the cat vocalized normally after healing.

Foreign body ingestion: children like to put objects in their mouth

Foreign body ingestion is a common problem in the pediatric age group. Infants and young children explore objects by putting them in the mouth. We reviewed the most recent literatures regarding the incidence, clinical presentation, as well as the most recent advances in the diagnostic and therapeutic modalities of foreign body ingestion in children. In 2007 more than 125 000 foreign body ingestions in patients of 19 years old and younger were reported to American Poison Control Centers in the USA. The majority of ingested foreign bodies pass spontaneously. Some foreign bodies can be harmful and require evaluation and intervention. The challenge in management is to distinguish the patients who require intervention from those who can be safely observed. In this review we suggest an algorithm for evaluation and management of children suspected to ingest a radiopaque foreign body.

Self-embedding Behavior: Radiologic Management of Self-inserted Soft-Tissue Foreign Bodies

To report on a series of self-embedding behavior (SEB), demonstrate the effectiveness and clinical effect of image-guided foreign body removal (IGFBR) in the treatment of embedded soft-tissue foreign bodies (STFBs), and evaluate the role of the radiologist in the clinical management of SEB. This retrospective study was approved by the institutional review board. From a database of 600 patients treated with IGFBR with ultrasonographic (US) and/or fluoroscopic guidance, self-injury was identified in 11 (1.8%) mainly adolescent patients with a mean age of 16 years (age range, 14-18 years). Evaluated data included number of foreign bodies; number of repeat episodes of foreign body insertion; location, type, and size of foreign body; incision size; imaging modality; and success or failure of foreign body removal. Seventy-six foreign bodies were inserted into the arm (n = 69), neck (n = 4), ankle (n = 1), foot (n = 1), or hand (n = 1) in the 11 patients. The number of STFBs per case ranged from one to 15. Foreign body types included metal (n = 40), plastic (n = 15), graphite (n = 12), glass (n = 4), wood (n = 3), crayon (n = 1), and stone (n = 1). STFB dimensions were 2.5-160.0 mm in length by 0.25-3.0 mm in thickness. Sixty-eight of the 76 STFBs were removed in the interventional radiology section. Incision lengths ranged from 4 to 8 mm (mean, 6 mm). The STFBs were removed with US guidance (n = 43), fluoroscopic guidance (n = 15), or a combination of the two modalities (n = 10). IGFBR was successful in all 68 cases, without complications. Greater awareness of SEB may result in radiologists being the first physicians to identify SEB and rapidly mobilize an interdisciplinary team for early and effective intervention and treatment. Percutaneous radiologic treatment of self-imbedded STFBs is safe, precise, and effective for radiopaque and nonradiopaque foreign bodies.

Erişkinlerde Trakeobronşiyal Yabancı Cisimler

Yabanci cisim aspirasyonu, acil girisim gerektiren ve yasami tehdit edici bir durum olusturabilir. Ulkemizde, ozellikle eriskinlerde yabanci cisim aspirasyonu oldukca siktir. Bu calismada amac, eriskinlerdeki trakeobronsiyal yabanci cisim aspirasyonlarinin etiyolojisi, klinigi, bronkoskopik tedavinin onemini belirterek tedavi sonuclarini degerlendirmektir. Ocak 1998 - Aralik 2003 arasinda Ondokuz Mayis Universitesi Tip Fakultesi Gogus Cerrahisi Anabilim Dali'nda trakeobronsiyal yabanci cisim aspirasyonu tanisiyla bronkoskopi uygulanan 53 hasta retrospektif olarak degerlendirildi. Tani hikaye, fizik muayene, radyolojik bulgular ve bronkoskopi ile konuldu. Hastalarin yas araligi 14-58 olup yas ortalamasi 24±1.6 yil idi. Hastalarin 44'u (%83) kadin, 9'u (%17) erkekti. Basvuru aninda 18 (%34) hasta semptomatikti ve en sik semptom oksuruktu (%17). En sik rastlanan radyografik anormallik radyo-opak yabanci cisim gorulmesi idi (%81). Bronkoskopi uygulanan hastalarin 50'sinde (%94) yabanci cisim tespit edildi, uc hastada yabanci cisime rastlanmadi. Uc hastaya rijid + fleksibl bronkoskopi uygulandi ve yabanci cisim cikarilmadi. Bu olgulara (%5.6) torakotomi + pnomotomi uygulandi. Yabanci cisimlerin; 24'u (%48) sag bronsiyal sistemde, 18'i (%36) sol bronsiyal sistemde ve 8'i (%16) trakeada tespit edildi. Yabanci cisimlerin buyuk cogunlugunun (%80) turban ignesi oldugu goruldu. Trakeobronsiyal yabanci cisim aspirasyonunda erken tani ve tedavi onemlidir. Trakeobronsiyal yabanci cisimler bronkoskopi ile basariyla cikarilabilir. Bolgelere ve ulkelere gore aspire edilen yabanci cisimler cesitlilik gostermektedir. Tracheobronchial Foreign Bodies in Adults Foreign body aspiration can be a life-threatening emergency requiring immediate intervention. In our country and especially in adults, the prevalence of foreign bodies aspiration is high. In this study, the aim is to evaluate results of the treatment, as well as pointing the importance of bronchoscopic treatment, and etyology and clinics of tracheobronchial foreign bodies in adults. Between January 1998 and December 2003, at Ondokuz Mayis University Medical School, Department of Thoracic Surgery, 53 patients were examined with a suspicion of tracheobronchial foreign body aspirations, retrospectively. The diagnosis was made on history, physical examination, radiological methods and bronchoscopy. The age interval of the patients was 14 to 58 and the mean age was 24±1.6 years. Nine (17%) of them were male and 44 (83%) of them were female. Eighteen (34%) patients were symptomatic on admission and the most frequent symptom was cough (17%). The most common radiographic abnormality found in 81% of the cases was a radiopaque foreign body. All 53 patients had bronchoscopic evaluation, and at 50 (94%) of them foreign bodies were identified. Only in three cases a foreign body was not found during the bronchoscopy. In 3 (5.6%) cases, in which rigid + flexible bronchoscopy were unsuccessful, thoracotomy + pneumotomy was applied. Foreign bodies were localized in the right bronchial tree in 24 (48%) cases, in the left bronchial tree in 18 (36%) cases and in the trachea in 8 (16%) cases. The majority of the foreign bodies were turban pins, in 40 (80%) cases. Early diagnosis and treatment is important in tracheobronchial foreign body aspiration. Tracheobronchial foreign bodies can be successfully removed with bronchoscopy. Aspired foreign bodies vary from region to region and country to country.

High-Resolution Sonography Is Effective in Detection of Soft Tissue Foreign Bodies

Patients with penetrating trauma or field injuries are commonly encountered by emergency physicians. Clinical examination by inspection or palpation can detect superficial foreign bodies (FBs), and radiographs can detect radiopaque FBs. However, soft tissue FBs can be easily missed. The aim of our series was to evaluate the role of high-resolution sonography in detection of soft tissue FBs. All patients referred to our center for sonographic evaluation of suspected soft tissue FBs from 1999 to 2008 were included in this analysis. Patients were scanned with an ultrasound machine using a 7.5-MHz transducer. The suspected area was scanned in both axial and sagittal planes. The nature of the FB, length, and depth from the surface were recorded and reported. The presence of an FB was confirmed by surgical excision. During the study period, 123 patients underwent sonography for a suspected FB, of which 12 were lost to follow-up and excluded from the analysis. The study group included 73.8% male patients; the mean age was 36.2 years. Wood fragments and wooden thorns were the most frequently observed FBs, at 46.2% and 36.2%, respectively. The surgeon was satisfied with the reported depth of the FB from the surface in most cases (89%). The overall sensitivity and specificity of sonography were 94.5% and 53.8%. High-resolution sonography is a very sensitive tool in diagnosis of soft tissue FBs. It also helps the surgeon with accurate localization, permitting easy removal.

Sonography of Jersey Finger

and injuries are common in everyday clinical practice. The diagnosis relies mainly on history and on a well-performed clinical examination. Nevertheless an imaging modality is usually required to confirm the clinical findings and to appreciate the extent of the damages.1 Standard radiographs are routinely obtained to evaluate bone fractures, joint instabilities, and the presence of radiopaque foreign bodies. In the last few years, sonography has gained wide acceptance as an efficient imaging modality of soft tissues.1–3 We report a case of traumatic osseous avulsion of the distal insertion of the flexor digitorum profundus (FDP) evaluated by standard radiography and sonography, which was then surgically confirmed.

Male With Pain in Left Hand

A 59-year-old right-handed professional painter presented to the emergency department with complaint of pain in the left hand. Approximately 2 hours before arrival, he was cleaning his high-pressure paint gun when it accidentally fired into his left palm. Physical examination revealed a small puncture wound at the distal palmar crease on the ulnar aspect of the left palm, with mild erythema and tenderness around the wound (Figure 1). Scar and skin retraction at the base of the small and ring fingers was also observed, which the patient said was longstanding and unrelated to the acute injury. Radiograph of the left hand revealed no fracture or radiopaque foreign body. The left hand was splinted and elevated. Intravenous antibiotics, analgesics, and tetanus prophylaxis were given. Hand surgeon consultation was obtained and the patient underwent urgent exploration of the hand in the operating room. High-pressure paint injection injury and unrelated Dupuytren's disease. Despite the innocuous early appearance of many high-pressure injection injuries, they are associated with a high rate of significant functional impairment and amputation.1Neal N.C. Burke F.D. High-pressure injection injuries.Injury. 1991; 22: 467-470Abstract Full Text PDF PubMed Scopus (58) Google Scholar The key to treatment is recognition of the severe nature of this injury and urgent surgical decompression and debridement to avoid extensive tissue destruction. The likelihood of amputation increases if debridement is delayed more than 6 hours.2Vasilevski D. Noorbergen M. Depierreux M. et al.High pressure injection injuries to the hand.Am J Emerg Med. 2000; 18: 820-824Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Our patient was taken urgently to the operating room for surgical decompression, debridement, and irrigation. A significant amount of latex paint was debrided from the soft tissues of the palm (Figure 2). The patient's Dupuytren's disease was excised incidentally to facilitate the debridement. The patient did well postoperatively and was discharged home, with arrangements for outpatient hand therapy.

Imaging of Orbital Trauma

Assessing traumatic orbital injuries is an important challenge for radiologists; this assessment is even more difficult when the orbital injury is associated with injuries involving multiple organs. Common posttraumatic orbital injuries include anterior chamber injuries, injuries to the lens, open-globe injuries, ocular detachments, intraorbital foreign bodies, carotid cavernous fistula, and optic nerve injuries. Radiographic examination of the orbits is rarely performed. Ultrasonography (US) can be very useful for evaluating the globe and its contents; however, US is contraindicated if a ruptured globe is suspected. Magnetic resonance imaging may be difficult to perform emergently; it is contraindicated if there is a possibility that a metallic intraorbital foreign body is present. Computed tomography (CT) is considered to be the top choice for evaluating orbital trauma. The best protocol is to obtain thin-section axial CT scans, then to perform multiplanar reformation. When evaluating a patient with an orbital injury, the radiologist should do the following: (a) evaluate the bony orbit for fractures, note any herniations of orbital contents, and pay particular attention to the orbital apex; (b) evaluate the anterior chamber; (c) evaluate the position of the lens (the lens may be displaced, and it may be either completely or partially dislocated); (d) evaluate the posterior segment of the globe, look for bleeds or abnormal fluid collections, and evaluate for radiopaque or radiolucent foreign bodies; and (e) evaluate the ophthalmic veins and the optic nerve complex, especially the orbital apex.

Aortic Pseudoaneurysm Caused by Migration of a Swallowed Sewing Needle

A white 64-year-old woman who made dresses for her livelihood was admitted to the emergency department for evaluation of acute chest pain and respiratory distress. Physical examination was unremarkable except for low arterial blood pressure (90 mm Hg systolic, 65 mm Hg diastolic), whereas ECG showed left atrial enlargement, possible previous septal myocardial infarction, negative T waves in the inferior leads, and no evidence of acute ischemia (Figure 1). Myocardial enzyme levels, including Troponin I, were within normal values after serial determination. Figure 1. ECG shows sinusal rhythm with 98 bpm, left atrial enlargement, possible previous septal myocardial infarction, and negative T waves in inferior leads. Chest x-ray was performed and showed a thin radiopaque foreign body at the 5° body of the thoracic vertebra level, near the trachea (Figure 2). When questioned specifically, the patient mentioned the possible accidental ingestion of …

Management of soft-tissue trauma to the face

The management of acute soft-tissue trauma can be very challenging for the facial plastic surgeon. The goals of management of facial trauma are the preservation of form and function. These goals are particularly important in facial soft-tissue trauma, where injuries can cause not only esthetic deformities but also can affect neural function, normal mastication, visual fields, and salivary outflow. This article outlines the evaluation and treatment of acute soft-tissue facial trauma. The key components include allowing for the stabilization of the patient, complete examination of the injury and face, thorough wound irrigation and debridement of necrotic tissue, preservation of all viable tissue, tension-free closure, and realignment of important facial esthetic structures. Special consideration must be given to injuries of functional structures such as the facial nerve, ductal systems or organs, and ensuring appropriated management of these structures.

Conventional radiographs: are they still the standard in localization of projectiles?

The penetration of air gun pellets in facial soft tissue can cause major problems during the removal of foreign bodies, although conventional radiography, computed tomography, image-guided surgical removal, and ultrasound have been applied to facilitate the procedure. It was the aim of the present case report to introduce a modified intraoperative method for the localization of air gun pellets, based on the use of radiopaque markers in conventional radiographs. A 66-year-old patient attempted to commit suicide by using an air gun. The pellet hit the right temporal region. A computed tomographic (CT) scan was acquired to localize the foreign body. The first attempt to remove the pellet through the penetrating wound failed. Because of a dislodgement of the pellet, the CT scan could no longer be used for the localization of the air gun pellet. As the air gun pellet was positioned under the zygomatic arch, ultrasound was unable to identify its position. Successful intraoperative localization of the projectile was performed after fixation of radiopaque markers to the skin in the region of the estimated localization, with conventional radiographs in 2 planes, acquired with a mobile dental x-ray device. Although the markers remained attached to the patient as reference makers, the air gun pellet was removed easily. The use of radiopaque markers in conventional radiographs in 2 planes allows fast, intraoperative localization of radiopaque foreign bodies within soft tissue. The procedure can be carried out with a conventional x-ray device that should be available in every oral and maxillofacial practice. The use of reference markers should be considered a standard procedure for the localization of radiopaque foreign bodies in the head and neck.

Silver nitrate masquerading as a radiopaque foreign body

Silver nitrate is commonly used as a method of chemical cauterization to areas of hypergranulation. We report two cases wherein silver nitrate in the hand was misinterpreted radiologically as foreign bodies.

Intraorbital Glass Foreign Body Missed on CT Imaging

A 36-year-old woman presented with a 7-week history of foreign body sensation in the superior right orbit after orbital trauma sustained during an accidental face-down fall onto a broken drinking glass. CT identified a 10.35 x 3.91-mm radiopaque foreign body in the right orbit superolateral to the globe. Orbital exploration superficial to the levator palpebrae superioris aponeurosis in close proximity to the site occupied by the CT-identified foreign body revealed an additional glass intraorbital foreign body, 4.0 x 2.5 x 0.25 mm in dimension. The second glass foreign body was entirely missed on the preoperative, 1-mm axial scans combined with sagittal and coronal reconstructed images and plain radiography.