Missing Radiopaque Foreign Body in Plain X-ray

Introduction: Retained foreign bodies are the external objects lying within the body, which are placed with voluntary or involuntary intentions. The involuntarily or accidentally, and complicated cases with the retained foreign body may come to the emergency services, which may require rapid and adequate imaging assessment. Materials and methods: We share our experience with six different cases with retained foreign bodies, who visited emergency radiological services with acute presentation of symptoms. The choice of radiological investigation considered based on the clinical presentation of the subjects with a retained foreign body. Conclusion: Patients with the retained foreign body may present acute symptoms to the emergency medical or surgical services, radiologists play a central role in rapid imaging evaluation. Radiological investigation plays a crucial role in identification, localization, characterization, and reporting the complication of the retained foreign bodies, and in many scenarios, radiological investigations may expose the unsuspected or concealed foreign bodies in the human body. Ultimately radiological services are useful rapid assessment tools that aid in triage and guide in the medical or surgical management of patients with a retained foreign body. Keywords: Imaging of foreign body; Retained foreign body; Emergency radiology; Trichobezoar with intussusception; Scalpel in pleura; Handle shower in rectum; Gun shot injury; Air way foreign body Arch Clin Med Case Rep 2020; 4 (5): 952-968

Retained foreign bodies are the external objects lying within the body, which are placed with voluntary or involuntary intentions. The involuntarily or accidentally, and complicated cases with the retained foreign body may come to the emergency services, which may require rapid and adequate imaging assessment.

Emergency Medicine Investigations, 2017

Background: According to Advanced Trauma Life Support, chest radiography must be performed during the initial evaluation of patients with trauma. We studied the CXR performed in the emergency room of Rajaie Hospital to determine its usefulness. Methods: In this prospective study, patients who referred with high-energy trauma from December 2013 until April 2014 were recruited. Their demographic characteristics, including age, gender, and cause of trauma were recorded. Meticulous medical history was taken from all patients and they were examined by emergency medicine specialist. Simple radiographic CXR was performed for selective patients and image findings and their mediastinal width were recorded. All statistical analysis was performed using SPSS software version 20.0 and P-value less than 0.05 was considered significant. Results: Of the total 790 patients assessed, 137 patients were female (17.3%) and 655 were male (82.7%). Mean age of patients was 35.13±17.01 (ranging from 12 to 91); Mean mediastinal width was 80.9±11.45 mm (range: 49.2-142.29). The most common causes of trauma included car-to-patient accident in 131 patients (16.5%), motor-to-car accident in 128 patients (16.2%), car turnover in 103 (13%), falling down in 93 (11.7%), and stab wound 88 (11.1%). The most common pathologic finding included rib fractures (42.7%), pneumothorax (11.6%), abnormal diaphragmatic findings (10.3%), and hemothorax (8.3%). Conclusion: The results of the current study, in accordance to previous studies, suggest rib fractures, pneumothorax, abnormal diaphragmatic findings, and hemothorax as the most frequent findings in CXR that need to be assessed meticulously. Moreover, the majority of patients were young males and the most frequent causes of trauma included car accidents, falling down, and stab wound. Therefore, paying attention to their diagnosis and treatment may increase the survival of this important group of patients.

Insights into Imaging, 2021

Open injuries bear the risk of foreign body contamination. Commonly encountered materials include gravel debris, glass fragments, wooden splinters or metal particles. While foreign body incorporation is obvious in some injury patterns, other injuries may not display hints of being contaminated with foreign body materials. Foreign objects that have not been detected and removed bear the risk of leading to severe wound infections and chronic wound healing disorders. Besides these severe health issues, medicolegal consequences should be considered. While an accurate clinical examination is the first step for the detection of foreign body materials, choosing the appropriate radiological imaging is decisive for the detection or non-detection of the foreign material. Especially in cases of impaired wound healing over time, the existence of an undetected foreign object needs to be considered.Here, we would like to give a practical radiological guide for the assessment of foreign objects in...

Journal of the American College of Surgeons, 2006

Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 2015

This report describes an unusual case of a missed foreign body (bamboo stick) that was subsequently discovered in the left infratemporal space. The clinical symptoms were such that the possibility of a foreign body sitting there was least anticipated. So, taking into consideration the diagnostic delay and long-standing mistreatment endured by the patient before reporting to us, and with conventional images proving unhelpful, it was decided to have the case thoroughly investigated using sophisticated imaging techniques to not only circumvent possible complications associated with surgery but also thwart the possibility of further mismanagement.

Trauma, 2019

Penetrating chest trauma to children is rare in the UK, making up 0.8% of wounds to children. When it does occur, it often results in damage to mediastinal structures including but not limited to the heart, lungs and great vessels. Rarely foreign objects can be intrapericardial. We present the case of a 14-year-old boy who presented haemodynamically stable following pellet gun wound to the chest. Multi-modality imaging revealed the bullet to be in the pericardium without associated cardiothoracic injuries, confirmed following surgery. Although a multi-modality imaging approach was used in diagnosing the precise location of the gun pellet, including imaging involving ionising radiation, we argue that early localisation can potentially be achieved with initial imaging and basic anatomical correlation, reducing the time to diagnosis. Using all the images available, including CT scout images, can assist in localisation and identifying important negatives.

Medical journal of Zambia, 2021

This case report presents the role imagingplayed in the diagnosis and surgical removal of multiple percutaneous foreign bodies in a 5-year-old child who presented with non-accidental injuries (NAI) to medical facilities in Zambia. Children are commonly referred for imaging with suspected accidental foreign bodies, but percutaneous foreign bodies due to NAI are rare. NAI is caused due to child physical abuse and therefore, imaging plays a major role in the diagnosis and provision of legal evidence. In this case report, conventional radiography (plain film) of askeletal survey was the first imaging requested. This was supplemented with a computed tomography (CT) scan of the thorax and abdomen. Lastly, foreign bodies were removed under the guidance of the image intensifier. Although, the cases of NAI reported and presented in medical facilities in Zambia are rare, this case shows that physical child abuse is practiced in our communities. Thus, radiographers and radiologists should pay attention to such cases during imaging and reporting, respectively.

2017

The purpose of the study is to highlight the importance of systematic approach and investigation for identification of potential life threatening lesions to a serious injured patients with the presence of obvious other lesions. Material and method: A clinical case patient, with penetrating transfixing chest trauma, severe shock and respiratory distress. Results: HEMS emergency evacuation under aggressive resuscitation, to a regional trauma center. Further clinical examination, imagistic and complex biomarkers revealed cardiac, lung, spleen and spinal cord contusions. Emergency intervention practiced foreign body extraction, extensive exploration, regulate and surgical treatment of the wound trajectory. Two weeks later, the patient has been discharged from hospital without complications. Conclusions: 1. Patient with opened, penetrating chest trauma should be considered and managed as a life threatening situation but the assessment plan and the investigation strategy required should b...

Pediatric Radiology, 2006

Background: Rib fractures in children under the age of 2 years have a strong correlation with non-accidental injury (NAI). Follow-up radiographs can improve detection. Objective: To evaluate the value of the follow-up chest radiograph in suspected non-accidental injury. Materials and methods: The study included all children less than 2 years of age who were investigated for suspected NAI in our institution between patients were asked to attend for a follow-up chest radiograph. From January 2000 onwards all children were asked to reattend. Results: Of 200 children included in the study, 59 (29.5%) reattended for a follow-up chest radiograph. The follow-up film provided useful additional information in 7 (12%) of the 59 children. In two children rib fractures were noted only on the follow-up chest radiograph. In a further two patients additional rib fractures were noted. Additional dating information was obtained for two patients. For one child both additional fractures and dating information were noted. Conclusions: The follow-up chest radiograph provides useful information in children with suspected NAI and it is recommended that it should be included routinely in the imaging investigations of these children.