Tattoo image composed of radiopaque deposits demonstrated by postmortem computed tomography

Post-traumatic cerebral infarction caused by thrombus in the middle cerebral artery

A woman in her 80s was found unconscious after being hit by a car while crossing a road. After admission to hospitals, computed tomography (CT) scans revealed traumatic brain injury (TBI), and the patient was treated symptomatically. However, despite improvement of TBI in CT images, she died unexpectedly. Postmortem CT demonstrated cerebral infarction in the territory of the right middle cerebral artery (MCA). Histopathological examination revealed lumen-obstructing thrombosis and intimal injury upstream of the thrombosis in the right MCA. These findings suggested that the intimal injury in the MCA had led to thrombus formation, and thromboembolism in the region distal to the injury leading to post-traumatic cerebral infarction (PTCI). Both postmortem CT and autopsy were able to reveal the final condition of the deceased, which had not been fully anticipated by the clinicians who had treated her after the accident. The longitudinal antemortem to postmortem course revealed by multiple CT images and the histopathological examination provided crucial clues to the pathogenesis of PTCI in this case.

Chemical characterization of inks in skin reactions to tattoo

Skin reactions are well described complications of tattooing, usually provoked by red inks. Chemical characterizations of these inks are usually based on limited subjects and techniques. This study aimed to determine the organic and inorganic composition of inks using X-ray fluorescence spectroscopy (XRF), X-ray absorption spectroscopy (XANES) and Raman spectroscopy, in a cohort of patients with cutaneous hypersensitivity reactions to tattoo. A retrospective multicenter study was performed, including 15 patients diagnosed with skin reactions to tattoos. Almost half of these patients developed skin reactions on black inks. XRF identified known allergenic metals - titanium, chromium, manganese, nickel and copper - in almost all cases. XANES spectroscopy distinguished zinc and iron present in ink from these elements in endogenous biomolecules. Raman spectroscopy showed the presence of both reported (azo pigments, quinacridone) and unreported (carbon black, phtalocyanine) putative organic sensitizer compounds, and also defined the phase in which Ti was engaged. To the best of the authors' knowledge, this paper reports the largest cohort of skin hypersensitivity reactions analyzed by multiple complementary techniques. With almost half the patients presenting skin reaction on black tattoo, the study suggests that black modern inks should also be considered to provoke skin reactions, probably because of the common association of carbon black with potential allergenic metals within these inks. Analysis of more skin reactions to tattoos is needed to identify the relevant chemical compounds and help render tattoo ink composition safer.

Tattoo Pigment in an Intramammary Lymph Node Mimicking Breast Malignancy

There are many patterns of microcalcification in mammography. Distinguishing between these patterns can be challenging. A malignant cause needs to be assessed through further diagnostic workup. We present a case of a 36-year-old BRCA1 mutation carrier, presenting with a small mass containing calcification on her screening mammogram. A vacuum-assisted biopsy under tomosynthesis guidance was performed and demonstrated an intramammary lymph node showing prominent extracellular black pigment. To our knowledge, this is the first case report of tattoo pigment mimicking breast malignancy on mammography.

Much 'tattoo' about nothing; Tattoo pigment mimicking breast microcalcifications on mammography

Mimics of calcifications on mammography are not uncommon and result in additional investigations that can cause patient anxiety. We describe the case of a 63 year old male who underwent further investigation of calcifications in the superior right breast. Additional imaging and patient examination revealed that the calcifications were located in a color tattoo overlying the medial right pectoralis muscle and actually represented the radio-opaque metallic compounds found in tattoo pigment.

Tattoo pigment mimicking axillary lymph node calcifications on mammography

Axillary lymph nodes can appear abnormal on mammography due to uptake of tattoo pigment and a malignant cause must be excluded through diagnostic workup. Furthermore, tattoo pigment can mimic malignant pathology at surgery or confound appropriate staging of breast cancer. We present the case of a 47-year-old female with left axillary lymph nodes demonstrating new coarse densities suspicious for malignant calcifications on screening mammogram. Stereotactic guided biopsy was performed which demonstrated pigment from a recent tattoo located on the patient's back and/or flank. Awareness of current or prior tattoos in a patient is helpful to properly manage such cases.