Image-guided percutaneous removal of ballistic foreign bodies secondary to air gun injuries

Fluoroscopy-Guided Metallic Foreign Body Removal: A Report of Three Cases and Literature Review

Ingested foreign objects that become trapped in the upper aerodigestive tract is a common issue that arises in Otolaryngology-Head and Neck Surgery practice. In these circumstances, it is advised to explore the neck using an external method to remove the item. However, locating the foreign body might be challenging. Not all metallic foreign body (MFB) patients require surgery, especially those without symptoms or complications. The standard X-ray and CT images are routinely examined for preoperative assessment and localization. Removal can be accomplished via flexible pharyngo-laryngoscopy or upper gastrointestinal endoscopy. Fluoroscopy is a widely accessible, minimally invasive, but underutilized tool during procedures. It offers an accurate intraoperative assessment of the foreign body in real-time. To allow the planning of a secure extraction pathway, the target should be radiopaque. In this report, we present three unique cases in which we used fluoroscopic imaging for guidance to remove a foreign body in the head and neck region in Prince Sultan Military Medical City in Riyadh, Saudi Arabia. In the first case, a young male presented with a history of foreign body sensation and odynophagia in the throat after eating a (shawarma) sandwich. In the second case, a six-year-old boy presented to the emergency department (ED) with epistaxis after being exposed to an air gun shot to his face. In the third case, a 40- year-old male presented after exposure to an air gun shot to the neck. After identification of the foreign body, all three patients were referred to Otolaryngology-Head and Neck. After radiological images have been done to confirm the presence of foreign objects, all three had a minimally invasive procedure to remove the metallic foreign bodies under fluoroscopic guidance without needing extensive surgery. All the procedures went well with no immediate complications with discharge on the same day. Fluoroscopy-guided removal of foreign bodies related to metabolic forging is a promising technique with several advantages, including real-time visualization, reduced invasiveness, and shorter recovery times. However, it is essential to weigh the benefits against the risks associated with radiation exposure and inherent limitations in detecting non-metallic objects. Further research and clinical studies are needed to optimize this technique and establish evidence-based guidelines for its application in the field of metabolic forging bodies.

Subcutaneous Low-Density Foreign Bodies Detection via Grating-Based Multimodal X-ray Imaging

Detecting low-density foreign bodies within soft tissues still stands for a serious challenge. Grating-based multimodal X-ray imaging typically has low hardware requirements while simultaneously providing three kinds of imaging information, i.e., absorption, phase-contrast, and dark-field. We aimed to explore the capacity of grating-based multimodal X-ray imaging technology for detecting common foreign bodies within subcutaneous tissues, and to assess the advantages as well as disadvantages of the three kinds of images obtained via grating-based X-ray multimodal technology in relation to diverse kinds of foreign bodies within different tissues. In this study, metal, glass, wood, plastic, graphite, and ceramic foreign bodies were injected into chunks of the pig adipose tissue and chicken thigh muscles. Next, a grating-based multimodal X-ray imaging device developed in our laboratory was used to detect the above foreign bodies within the adipose and muscle tissues. Our results show that grating-based multimodal X-ray imaging clearly revealed the subcutaneous foreign bodies within the adipose and muscle tissues by acquiring complementary absorption, phase-contrast, and dark-field imaging data in a single shot. Grating-based multimodal X-ray imaging has an exciting potential to detect foreign bodies underneath the epidermis.

Pediatric upper extremity firearm injuries: an analysis of demographic factors and recurring mechanisms of injury

BACKGROUND

Little is known regarding risk factors specific to pediatric upper extremity firearm injuries. The purpose of this study is to evaluate pediatric patients treated for these injuries to identify at-risk populations and recurring mechanisms of injury.

METHODS

A 20-year retrospective review was conducted. Patients 17 years of age and younger, with upper extremity injuries related to a firearm, were included. Analysis involved Fisher's exact and Chi-square tests.

RESULTS

One hundred and eighty patients were included. The mean age was 12.04 ± 4.3 years. Most included patients were male (85%). Interestingly, females were more frequently victims of assault (P = 0.03), and males were more frequently injured due to accidental discharge (P < 0.001). The most affected race/ethnicity was White-not Hispanic or Latino (48%). The hand was the most frequent location injured (31%) and was more likely to be accidental than proximal injuries (P = 0.003). Air rifles were the most common firearm type used (56%). Pistols were implicated in 47 (26%) cases, rifles in 17 (9%), and shotguns in 10 (6%). Ninety-nine (55%) patients had procedures in the operating room. The most frequent procedure was foreign body removal (55%).

CONCLUSIONS

Risk factors such as male sex, White-not Hispanic or Latino race/ethnicity, and adolescent age were attributed to increased risk for injury. Male sex was associated with increased risk of injury by accidental discharge and female sex with intentional assault. Air rifles were the most common firearm type overall, although female sex was associated with increased risk for injury by powder weapon.

Balloon tract dilatation facilitates fluoroscopically guided removal of deeply penetrating foreign bodies

Previous reports describe removal of foreign bodies using image guidance with serial tract dilation or blunt and sharp dissection techniques. This report describes a novel technique utilizing balloon tract dilatation to facilitate the removal of retained radiopaque soft tissue foreign bodies under fluoroscopic guidance. This technique offers a minimally invasive approach for rapid retrieval of deeply penetrating foreign bodies, obviating the need for a large incision or surgical cut down.