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Zokri MF, Naffi AA, Mustapha M, Othman O. An Unusual Presentation of Posterior Globe Rupture Detected During Pars Plana Vitrectomy. Cureus 2024; 16:e59564. [PMID: 38826969 PMCID: PMC11144285 DOI: 10.7759/cureus.59564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
A 54-year-old gentleman presented with a history of poor vision in the right eye for three months and a prior forgotten trauma. The anterior segment was normal. He was diagnosed with subtotal bullous rhegmatogenous retinal detachment (RRD), but no apparent tear was observed. Vitrectomy commenced, and upon exploration, there was a posterior globe rupture with retinal and vitreous incarceration. The scleral wound was sutured with heavy liquid in situ. Orbital imaging post-surgery revealed the presence of an intraorbital foreign body. This is a peculiar presentation of posterior globe rupture, as it was unperceived by the patient, and the slit lamp examination conducted indicated no clinical evidence. Identifying posterior globe rupture remains a challenge that necessitates a high index of suspicion and appropriate management.
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Affiliation(s)
- Mohd Faizal Zokri
- Ophthalmology, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, MYS
| | - Ainal Adlin Naffi
- Ophthalmology, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, MYS
| | | | - Othmaliza Othman
- Ophthalmology, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, MYS
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2
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Udelhoven A, Kettner M. [Orbital trauma]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:189-195. [PMID: 38345620 DOI: 10.1007/s00117-024-01272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/22/2024]
Abstract
Orbital trauma can occur independently or in conjunction with other craniofacial trauma and can cause damage to bony and neurovascular structures as well as soft tissues. Appropriate interdisciplinary treatment of patients is essential to prevent long-term damage such as blindness or muscle dysfunction. Even complex fractures and soft tissue damage can be visualized using modern thin-layer computed tomography (CT), which is necessary for proper treatment.
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Affiliation(s)
- Anne Udelhoven
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Neurozentrum (Geb. 90), Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66421, Homburg/Saar, Deutschland.
| | - Michael Kettner
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Neurozentrum (Geb. 90), Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66421, Homburg/Saar, Deutschland
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Liu X, Bai Q, Song X. Clinical and imaging characteristics, outcomes and prognostic factors of intraocular foreign bodies extracted by vitrectomy. Sci Rep 2023; 13:14136. [PMID: 37644096 PMCID: PMC10465480 DOI: 10.1038/s41598-023-41105-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
To investigate the clinical and computer tomography (CT) features and visual prognostic factors of pars plana vitrectomy (PPV) for management of retained posterior segment intraocular foreign body (IOFB). Medical records of 96 patients with IOFB removed by PPV between July 2017 and June 2021 were retrieved. The medical records, including demographic data, initial and final best corrected visual acuity (BCVA) using standard Snellen chart, characteristics of IOFB, CT findings, and surgical details, were reviewed. Outcome was evaluated according to the final BCVA and prognostic factors were obtained. The mean age was 42.31 ± 12.05 years (range 13-71 years) with 94 males (97.9%) and two females (2.1%). CT was sensitive of IOFB in 93.75% (90 eyes) and the locations were consistent with that found during PPV: 20 foreign bodies were located in vitreous, 6 near ciliary body, and 70 on or in retina. Mean diameter of IOFB removed by PPV is 3.52 mm ± 3.01 mm (range 1-22; median 3), and mean area is 6.29 ± 6.48 mm2 (range 0.5-40; median 3), which was statistically associated with the initial VA < 0.1 and endophthalmitis. Endophthalmitis was found in 24 (25.0%) eyes and large wound together with scleral entry site might be related to the endophthalmitis. Visual outcome < 0.1 was associated with relative afferent pupillary defect, initial VA < 0.1, and presence of endophthalmitis. Initial VA ≥ 0.1 was independent predictive factor for a better final BCVA. Relative afferent pupillary defect, initial BCVA < 0.1, and presence of endophthalmitis are poor visual prognostic factors.
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Affiliation(s)
- Xin Liu
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130041, Jilin, China
| | - Qinzhu Bai
- Department of Radiology, The Second Hospital of Jilin University, #4026 Yatai Street, Changchun, 130024, China
| | - Xiande Song
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130041, Jilin, China.
- Department of Ophthalmology, The First Hospital of Qiqihar, #30 Gongyuan Road, Qiqihar, 161005, Heilongjiang, China.
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Sasindran V, John MS, Augustian SM. Removal of Intraorbital Foreign Body by Transnasal Endoscopic Approach Removal of Intraorbital Foreign Body by Transnasal Endoscopic Approach. Indian J Otolaryngol Head Neck Surg 2023; 75:1090-1092. [PMID: 37206704 PMCID: PMC10188884 DOI: 10.1007/s12070-023-03596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 02/16/2023] [Indexed: 03/08/2023] Open
Abstract
Foreign bodies in the intra-orbital area are a rare occurrence. It can be metallic or non-metallic. Intra-orbital foreign bodies can present with a variety of complications depending upon its size and location. We report a case of intra-orbital foreign body which was successfully removed by trans-nasal endoscopic approach.A 12 year old boy with an intra-orbital wooden foreign body in the medial extra-conal space was presented three days post trauma. He had normal visual acuity but there was painful restriction of eye movement. Foreign body was removed and pus drained by trans-nasal endoscopic approach. Post operatively he gradually regained his eye movements. Post operatively patient had complete recovery of eye movements. Traditionally intra-orbital foreign bodies were removed by external approach. With advancement in technology medial intra-orbital foreign bodies can be removed by trans-nasal endoscopic approaches.
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Affiliation(s)
- Vivek Sasindran
- Department of ENT, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala 689101 India
| | - Mithra Sara John
- Department of ENT, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala 689101 India
| | - Sherin Maria Augustian
- Department of ENT, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala 689101 India
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You Y, Wang X, Cheng S, Zhu R, Wang B, Li S, Jiang F. Clinical analysis of 96 patients with intraorbital foreign bodies: A 10-year retrospective study. Front Med (Lausanne) 2022; 9:1018905. [DOI: 10.3389/fmed.2022.1018905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
IntroductionTo investigate the clinical manifestations, diagnosis, and surgical treatment of intraorbital foreign bodies (IOFBs).MethodsPatients with IOFBs were enrolled from Wuhan Union Hospital between January 2011 and January 2021. Demographic and clinical information was extracted, including gender, age, cause and entrance of the trauma, material, size and quantity of foreign body, visual function, ocular complications, imaging findings, and surgical intervention. The patients were divided into two groups according to the timeline, group A (from January 2011 to December 2015, n = 39) and group B (from January 2016 to January 2021, n = 57).ResultsThe 96 patients (81 men and 15 women) were enrolled in this series, with a median age of 39.5 (1.6–76.0) years. Work-related injuries were the cause of IOFBs in 45 individuals (46.9%). Three patients (3.3%) presented severe visual impairment, and 39 patients (42.4%) presented blindness. The majority of foreign bodies were metal (44.8%), followed by wood (26.0%). Computed tomography (CT) and magnetic resonance imaging (MRI) were performed, respectively, on 89 (92.7%) and 21 (21.9%) patients with IOFBs, in which the detection rate was 80.9% for CT and 81.0% for MRI. Among the 25 patients with intraorbital wooden foreign bodies (IOWFBs), the utilization and detection rates of MRI were 50.0% and 40.0% in group A, and 93.3% and 92.9% in group B, with significant differences in both rates between the two groups (both P < 0.05). The IOWFBs detection rate in MRI was significantly higher than that in CT (78.9% vs. 45.8% overall and 92.9% vs. 53.5% in group B). The detection rates of IOFBs and IOWFBs in initial surgery were statistically different between the two groups, of which the rates were 84.6% and 40.0% in group A and 98.2% and 93.3% in group B. The reoperation rate of IOWFBs in group B (20.0%) was significantly lower than that in group A (70.0%).ConclusionIOFBs were mainly caused by work-related injuries and might lead to serious visual impairment. The application and detectability of MRI in IOWFBs improved in recent years, and MRI presented better detectability than CT in diagnosing IOWFBs. Thus, MRI should be recommended despite negative CT findings.
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Lai K, Laycock J, Bates A, Hamann J. Sino-orbital foreign body caused by a slingshot injury in a young boy. BMJ Case Rep 2022; 15:e251214. [PMID: 36104034 PMCID: PMC9476118 DOI: 10.1136/bcr-2022-251214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Slingshots or hand catapults, historically used as a military or hunting weapon, are common toys among children and young teenagers. Their use can be dangerous as a strike to the eye or orbit can result in significant injuries including blindness. We describe a rare case of a sino-orbital foreign body caused by a slingshot injury in a young boy. The case was managed by a multidisciplinary team involving ear, nose and throat, ophthalmology and paediatrics, and the foreign body of a metal ball bearing was removed using an endoscopic transnasal approach. Although the patient made a good recovery, the case highlights the danger of slingshot devices misused by children.
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Affiliation(s)
- Kenneth Lai
- ENT, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Juliet Laycock
- ENT, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Adam Bates
- Ophthalmology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - Julian Hamann
- ENT, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
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Cellina M, Cè M, Marziali S, Irmici G, Gibelli D, Oliva G, Carrafiello G. Computed tomography in traumatic orbital emergencies: a pictorial essay-imaging findings, tips, and report flowchart. Insights Imaging 2022; 13:4. [PMID: 35022818 PMCID: PMC8755868 DOI: 10.1186/s13244-021-01142-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
Computed tomography (CT) is considered the gold standard technique for the assessment of trauma patients with suspected involvement of the eye and orbit. These traumas can result in dramatic consequences to visual function, ocular motility, and aesthetics. CT is a quick and widely available imaging modality, which provides a detailed evaluation of the orbital bony and soft tissue structures, an accurate assessment of the globes, and is used to guide the patients’ treatment planning. For a timely and accurate diagnosis, radiologists should be aware of fracture patterns and possible associated complications, ocular detachments and hemorrhages, and different appearances of intraorbital foreign bodies. This educational review aims to describe all post-traumatic orbital abnormalities that can be identified on CT, providing a list of tips and a diagnostic flowchart to help radiologists deal with this complex condition.
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Affiliation(s)
- Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Maurizio Cè
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy
| | - Sara Marziali
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy.
| | - Giovanni Irmici
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy
| | - Daniele Gibelli
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Giancarlo Oliva
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Gianpaolo Carrafiello
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy.,Radiology Department, Policlinico di Milano Ospedale Maggiore, Fondazione IRCCS Ca' Granda, Via Francesco Sforza, 35, 20122, Milan, MI, Italy
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Schmuter G, Stern EM, Packles M. Considerations for a Retained Foreign Body in the Posterior Orbital Apex. Cureus 2021; 13:e19228. [PMID: 34877206 PMCID: PMC8641400 DOI: 10.7759/cureus.19228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 12/03/2022] Open
Abstract
Orbital foreign bodies must be approached with complex considerations involving their precise location and composition in order to adequately guide management. Physicians must carefully weigh the advantages and risks of surgical and medical intervention compared to conservative management. We present a case of a male patient with penetrating trauma to the eye that resulted in open globe injury and orbital foreign body, presumed metallic, at the posterior orbital apex near the optic nerve. As such, despite the uncertainty of the exact composition of the object, the medical team and patient agreed to conservative management given its high-risk anatomical location.
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9
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Tong JY, Juniat V, Patel S, Selva D. Radiological characteristics of mixed composition intraorbital foreign body. BMJ Case Rep 2021; 14:e245638. [PMID: 34645635 PMCID: PMC8515427 DOI: 10.1136/bcr-2021-245638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/03/2022] Open
Abstract
Orbital trauma is commonly complicated by retention of intraorbital foreign bodies. A 39-year-old man presented following a penetrating injury to the right orbit, with CT evidence of foreign bodies in the right anterior and posterior medial orbit. The foreign bodies were found to be a mixed composition of metal and wood. Characterising wood on CT imaging is difficult due to its radiolucency and low density, which can be mistaken for air in the setting of traumatic orbital emphysema. Increasing the window width on bone window settings can be used to distinguish wood from air, which is crucial for facilitating its complete surgical removal.
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Affiliation(s)
- Jessica Y Tong
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Valerie Juniat
- Department of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Sandy Patel
- Department of Neuroradiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Department of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
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Retrospective Cohort Study of Frequency and Patterns of Orbital Injuries on Whole-Body CT with Maxillofacial Multi-Slice CT. Tomography 2021; 7:373-386. [PMID: 34449735 PMCID: PMC8396321 DOI: 10.3390/tomography7030033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background: High-impact trauma frequently leads to injuries of the orbit, but literature focusing on the viscerocranium rather than the neurocranium is underrepresented. Methods: Retrospective cohort study (2006–2014) at an urban level 1 trauma center assessing the frequency and typical patterns of orbital injuries on whole-body computed tomography (WBCT) with maxillofacial multi-slice CT (MSCT) after severe trauma. (1) Screening of consecutive WBCT cases for dedicated maxillofacial MSCT. (2) Examination by two independent experts’ radiologists for (peri-/)orbital injuries. (3) Case review for trauma mechanisms. Results: 1061 WBCT were included revealing 250 (23.6%) patients with orbital injuries. Less than one-quarter (23.3%) of patients showed osseous and 9.5% showed soft tissue injuries. Combined osseous and soft tissue lesions were present in 39.2% of orbital injuries, isolated soft tissue injuries were rare. Single- or two-wall fractures of the orbit were prevalent, and the orbital floor was affected in 67% of fractures. Dislocated extraocular muscles (44.6%), deformation of the ocular globe (23.8%), and elongation of the optic nerve (12.9%) were the most frequently soft tissue findings. Vascular trauma was suspected in 15.8% of patients. Conclusions: Orbital trauma was confirmed in 23.6% of cases with suspected facial injuries after severe trauma. Concomitant soft tissue injuries should be excluded explicitly in cases with orbital fractures to prevent loss of vision or ocular motility.
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Clinical Presentation and Management Strategies in Intraorbital Foreign Bodies. Case Rep Ophthalmol Med 2021; 2021:6645952. [PMID: 33859854 PMCID: PMC8026326 DOI: 10.1155/2021/6645952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/23/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
The authors present a retrospective, observational case study of seven patients, who presented with retained Intra-Orbital Foreign Bodies (IOrbFBs) following penetrating orbital injury at a tertiary eye hospital over a period of one year. Cases were reviewed for epidemiological features, mechanism of injury, nature of foreign body, clinical features, imaging modality, associated complications, management outcomes, and the final prognosis. The mean age of presentation was 27.43 years. Amongst the seven patients, two were children (aged <10 years). The male : female ratio was 4 : 3. Of the seven retained IOrbFBs, two were plastic, two wooden, and three metallic in nature (one gunshot injury, one ball projectile (commonly referred to as BB) injury, and one with knife). Two out of seven had no light perception at presentation. The periocular location of the foreign bodies was inferior in 4 cases and medial in 3 cases. Computed Tomography scan confirmed the diagnosis in five cases and Magnetic Resonance Imaging (MRI) was diagnostic in one. Surgical intervention was done in five cases, and two cases were managed conservatively. The authors conclude that favourable outcome can be achieved even without surgical removal in cases of inert metallic/inorganic IOrbFBs. The properties of plastic FBs can frequently render them invisible on imaging, or they may mimic chronic inflammatory conditions like tuberculosis. Long-standing wooden IOrbFBs evade identification radiologically due to prolonged hydration. The ultimate choice of intervention must be individualised, weighing the risks of retention against the risk of iatrogenic damage.
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Hoffmann B, Schafer JM, Dietrich CF. Emergency Ocular Ultrasound - Common Traumatic and Non-Traumatic Emergencies Diagnosed with Bedside Ultrasound. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:618-645. [PMID: 33291171 DOI: 10.1055/a-1246-5984] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Point-of-care ocular ultrasound (POCOUS) in the ambulatory and critical care setting has become an invaluable diagnostic tool for patients presenting with traumatic or atraumatic vision and ocular complaints. Sonographic bedside evaluation is intuitive and easy to perform and can accurately diagnose a variety of pathologies. These include detachment or hemorrhage of the retina or vitreous, lens dislocation, retrobulbar hematoma or air, as well as ocular foreign bodies, infections, tumors, and increased optic nerve sheath diameter that can be assessed in the setting of suspected increased intracranial pressure. The ocular anatomy is easy to visualize with sonography, as the eye is a superficial structure filled with fluid. Over the last two decades, a large number of scientific publications have documented that POCOUS in emergent or critical care settings is an accurate diagnostic tool and expands and improves emergency diagnosis and management. This article will review POCOUS exam techniques as well as normal sonographic findings and common pathologies.
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Affiliation(s)
- Beatrice Hoffmann
- Department of Emergency Medicine, Division of Emergency Ultrasound, Beth Israel Deaconess Medical Center, Boston, United States
| | - Jesse M Schafer
- Department of Emergency Medicine, Division of Emergency Ultrasound, Beth Israel Deaconess Medical Center, Boston, United States
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Abstract
Patients who experience trauma to the eyelid or the orbit may present to their primary care providers or directly to the emergency room for evaluation of their injuries. These patients will often be in pain and may have bleeding around the eye, which can make evaluation of these patients difficult. Many traumatic injuries to the eye require quick and immediate intervention. In this article, we will review the background, anatomy, exam and management of some of the most common eye traumas including eyelid lacerations, orbital hemorrhages, intraorbital foreign bodies, and orbital fractures.
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Affiliation(s)
- Abigail A Gordon
- Division of Internal Medicine, NorthShore University Health System, Evanston, IL, United States
| | - Lillian T Tran
- Division of Ophthalmology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States
| | - Paul O Phelps
- Division of Ophthalmology, NorthShore University Health System, 2050 Pfingsten Rd., Ste. 280, Glenview, IL 60026, United States; Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States.
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Chowdhary S, Garg P, Sawhney V, Pandya A, Sambhav K, Gupta S. Unusual Missed Diagnosis of Foreign Body: A Case Report. Int Med Case Rep J 2020; 13:187-190. [PMID: 32547254 PMCID: PMC7245452 DOI: 10.2147/imcrj.s246924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background Penetrating intraorbital foreign body (IOFB) is usually associated with high-velocity trauma forces around the eye. IOFB injury to globe or optic nerve is considered a surgical emergency; an immediate diagnosis and management plan is generally indicated. Methods A case report (design). The patient was a 78-year-old male presented with diminution of vision of the right eye following a high-velocity injury. The patient was noted to have a closed globe injury with associated retinal detachment and vitreous hemorrhage. An initial orbital CT scan did not reveal any IOFB, despite and intact globe. However, repeat a CT head and orbit scan revealed an intracranial magnetic foreign body lodged in the right frontal lobe. Conclusion A CT scan of the brain and paranasal sinuses should be obtained along with a CT orbit in case of high-velocity orbital/ocular trauma.
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Affiliation(s)
- Somya Chowdhary
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Pooja Garg
- Specialty Retina Centre, Coral Springs, FL, USA
| | | | | | - Kumar Sambhav
- Department of Ophthalmology, University of Florida, Jacksonville, FL, USA
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Grewal AM, Singh M, Yadav D, Kaur M, Singh J, Sharma M, Zadeng Z, Gupta P. Long-term ophthalmic anatomical and functional outcomes after surgical removal of intraorbital foreign bodies. Eur J Ophthalmol 2019; 31:263-270. [PMID: 31690103 DOI: 10.1177/1120672119885587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To analyze the anatomical and functional ophthalmic parameters after the surgical removal of various intraorbital foreign bodies. METHODS A retrospective analysis of medical records was performed featuring detailed history, ophthalmic examination, orbital computed tomographic scans, treatment details, and outcomes. The analyzed anatomical factors included extraocular movements, the position of the eyeball (proptosis, dystopia, and enophthalmos), and fullness of orbital sulci. The functional assessment was based on visual acuity, pupillary reactions, and diplopia. The outcomes were defined as complete, partial, and failure after a minimum follow-up of 1 year. RESULTS Of 32 patients, the organic and inorganic intraorbital foreign bodies were surgically removed from 18 (56.25%) and 14 (43.75%) orbits, respectively. At presentation, anatomically the extraocular movement restriction, proptosis/dystopia/enophthalmos, and orbital sulcus fullness were noted in 26 (81.25%), 24 (75%), and 15 (46.88%), respectively. Functionally, diminished visual acuity, diplopia, and pupil abnormalities were seen in 27 (84.38%), 14 (43.75%), and 8 (25%), respectively. After intraorbital foreign body removal at a mean follow-up of 14 months, the improvement of anatomical factors (same sequence) were observed in 8 (30.77%), 20 (83.33%), and 12 (80%), respectively. In functional factors (same sequence), the improvement was noted in none (0%), 13 (92.86%), and 5 (62.5%), respectively. Hence, the majority of patients (n = 20, 62.5%) achieved partial success, while 8 (25%) had complete success. Four (12.5%) had treatment failure despite similar management protocols. CONCLUSION The anatomical outcomes are better than the functional outcomes after surgical removal of the intraorbital foreign bodies. The visual acuity does not improve considerably after the surgical removal of intraorbital foreign bodies. Overall, the wooden intraorbital foreign bodies have poorer anatomical and functional prognosis.
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Affiliation(s)
- Aditi Mehta Grewal
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Singh
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Yadav
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jyoti Singh
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjula Sharma
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Zoramthara Zadeng
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Prince AD, Bauer AM, Xie Y, Prince ME. Wire bristle foreign body: Never in the same place twice. SAGE Open Med Case Rep 2019; 7:2050313X19853443. [PMID: 31191904 PMCID: PMC6542111 DOI: 10.1177/2050313x19853443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/07/2019] [Indexed: 12/01/2022] Open
Abstract
Foreign body ingestion is a common reason for visiting the emergency room. Foreign bodies can lodge anywhere in the upper aerodigestive tract and can sometimes be difficult to extract. Wire bristles that dislodge from grill-cleaning wire brushes and which are then accidentally swallowed can be particularly challenging to remove due to their small size, propensity to become embedded, and their ability to migrate through tissues. This case reveals the speed with which wire bristle foreign bodies can migrate through tissues and exemplifies the need to obtain computerized tomography evaluations in close proximity to any planned attempt to remove them.
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Affiliation(s)
| | - Ashley M Bauer
- Department of Otolaryngology-HNS, University of Michigan, Ann Arbor, MI, USA
| | - Yanjun Xie
- Department of Otolaryngology-HNS, University of Michigan, Ann Arbor, MI, USA
| | - Mark Ep Prince
- Department of Otolaryngology-HNS, University of Michigan, Ann Arbor, MI, USA
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Long B, Koyfman A, Gottlieb M. Esophageal Foreign Bodies and Obstruction in the Emergency Department Setting: An Evidence-Based Review. J Emerg Med 2019; 56:499-511. [PMID: 30910368 DOI: 10.1016/j.jemermed.2019.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with esophageal foreign bodies or food bolus impaction may present to the emergency department with symptoms ranging from mild discomfort to severe distress. There is a dearth of emergency medicine-focused literature concerning these conditions. OBJECTIVE OF THE REVIEW This narrative review provides evidence-based recommendations for the assessment and management of patients with esophageal foreign bodies and food bolus impactions. DISCUSSION Esophageal foreign bodies and food bolus impaction are common but typically pass spontaneously; however, complete obstruction can lead to inability to tolerate secretions, airway compromise, and death. Pediatric patients are the most common population affected, while in adults, edentulous patients are at greatest risk. Foreign body obstruction and food bolus impaction typically occur at sites of narrowing due to underlying esophageal pathology. Diagnosis is based on history and examination, with most patients presenting with choking/gagging, vomiting, and dysphagia/odynophagia. The preferred test is a plain chest radiograph, although this is not required if the clinician suspects non-bony food bolus with no suspicion of perforation. Computed tomography is recommended if radiograph is limited or there are concerns for perforation. Management requires initial assessment of the patient's airway. Medications evaluated include effervescent agents, glucagon, calcium channel blockers, benzodiazepines, nitrates, and others, but their efficacy is poor. Before administration, shared decision making with the patient is recommended. Endoscopy is the intervention of choice, and medications should not delay endoscopy. Early endoscopy for complete obstruction is associated with improved outcomes. CONCLUSIONS This review provides evidence-based recommendations concerning these conditions, focusing on evaluation and management.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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Hooper T, Eccles G, Milliken T, Mathieu-Burry JR, Reed W. Dose reduction in CT imaging for facial bone trauma in adults: A narrative literature review. J Med Radiat Sci 2019; 66:122-132. [PMID: 30706691 PMCID: PMC6545476 DOI: 10.1002/jmrs.319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 01/08/2023] Open
Abstract
Trauma to the facial area accounts for a significant number of admissions to the emergency department. Diagnostic imaging is almost always required, and is critical in determining patient management. Multi‐detector computed tomography (MDCT) appears consistently in the literature as the gold‐standard imaging modality for facial bones, but results in a high radiation dose to the patient. This makes the application and advancement of dose reduction and dose optimisation methods vital. This narrative review presents a critical analysis of the literature concerning diagnostic imaging of facial bone trauma, with an emphasis on dose reduction methods for MDCT. Databases including Pubmed, Medline, Web of Science and Scopus were used to investigate this topic, with the key words: facial bone trauma, computed tomography (CT) imaging and dose reduction. Exclusion criteria included studies on nasal bone fracturing, dental imaging, elective surgeries and paediatric imaging. The literature shows overwhelming support for MDCT, given its accuracy, efficiency and ease of operation. Noise reducing reconstruction algorithms show promise as a successful method of dose reduction in facial bone imaging. Investigations of more innovative techniques also appear within the literature, including diagnostic cone‐beam CT (CBCT), intraoperative CBCT and dual‐source CT (DSCT), but further research is required to confirm their clinical value.
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Affiliation(s)
- Tayla Hooper
- Discipline of Medical Radiation Sciences, the University of Sydney, Lidcombe, Australia
| | - Grace Eccles
- Discipline of Medical Radiation Sciences, the University of Sydney, Lidcombe, Australia
| | - Talia Milliken
- Discipline of Medical Radiation Sciences, the University of Sydney, Lidcombe, Australia
| | | | - Warren Reed
- Discipline of Medical Radiation Sciences, the University of Sydney, Lidcombe, Australia
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Tachibana K, Umemura H, Morizane S, Yamasaki O. Two cases of metallic foreign bodies hidden in recalcitrant wounds unexpectedly detected using magnetic resonance imaging. J Dermatol 2019; 46:e195-e196. [PMID: 30628117 DOI: 10.1111/1346-8138.14756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kota Tachibana
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Umemura
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Shin Morizane
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Osamu Yamasaki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Zuluaga-Orrego CA, Caicedo-Montaño CA, Alba-Bernal MP, Acosta-Velásquez V, Reyes-Vergara D, Santander-Guerrero JS. Pediatric ocular trauma: intraorbital foreign body. Case report. CASE REPORTS 2019. [DOI: 10.15446/cr.v5n1.75001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Penetrating traumas in the orbit and intraorbital foreign bodies during pediatric age are rare and could be associated with vascular and optic nerve injuries.Clinical case: Five-year-old female patient with penetrating trauma in left orbit of 1 hour of evolution caused by a brush after accidentally tripping with a classmate while painting during art class. The patient was taken the pediatric emergency department of the Clinica Universitaria Colombia in Bogotá where she was admitted, assessed with scanographic studies and taken to surgery to remove the intraorbital foreign body.Discussion: The case of this patient was characterized by indemnity of the eyeball, central artery and vein of the retina and optic nerve, in addition to timely and interdisciplinary management that reduced the risk of complications.Conclusions: The analysis of the clinical evolution of the patient allowed identifying the key events to approach this type of cases, as well as the multiple management and prognosis alternatives according to the type and trajectory of the penetrating object.
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Leung V, Dunn H, Beshay N, Smith J, O'Donnell B. Surfboard-related intraorbital foreign bodies: a case series and radiological considerations. Clin Exp Ophthalmol 2018; 46:702-705. [DOI: 10.1111/ceo.13161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/08/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Vannessa Leung
- Royal North Shore Hospital; Sydney New South Wales Australia
- University of Sydney; Sydney New South Wales Australia
- University of New South Wales; Sydney New South Wales Australia
| | - Hamish Dunn
- University of Sydney; Sydney New South Wales Australia
- Westmead Hospital; Sydney New South Wales Australia
| | - Nader Beshay
- Royal North Shore Hospital; Sydney New South Wales Australia
| | - James Smith
- Royal North Shore Hospital; Sydney New South Wales Australia
| | - Brett O'Donnell
- Royal North Shore Hospital; Sydney New South Wales Australia
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De Filippo M, Russo U, Papapietro VR, Ceccarelli F, Pogliacomi F, Vaienti E, Piccolo C, Capasso R, Sica A, Cioce F, Carbone M, Bruno F, Masciocchi C, Miele V. Radiofrequency ablation of osteoid osteoma. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:175-185. [PMID: 29350646 PMCID: PMC6179079 DOI: 10.23750/abm.v89i1-s.7021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/24/2023]
Abstract
Osteoid osteoma is a benign bone neoplasm with a reported incidence of 2-3% among all bone primary tumors. Although it is a small and benign lesion, it is often cause of patient complaint and discomfort. It is generally characterized by a long lasting, unremitting pain that typically exacerbates at night, often leading to sleep deprivation and functional limitation of the skeletal segment involved, with a significant reduction of patient daily life activities and consequent worsening of the overall quality of life. Over decades, complete surgical resection has represented the only curative treatment for symptomatic patients. In the last years, new percutaneous ablation techniques, especially radiofrequency ablation, have been reported to be a safe and effective alternative to classical surgery, with a low complication and recurrence rate, and a significant reduction in hospitalization cost and duration. The aim of this article is to provide an overview about the radiofrequency thermal ablation procedure in the treatment of osteoid osteoma. (www.actabiomedica.it)
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Vats M, Ramasamy S, Neogi S, Tudu SK. Ingestion of nine metallic nails with corrosive: what happened next? BMJ Case Rep 2017; 2017:bcr-2017-222338. [PMID: 29167219 DOI: 10.1136/bcr-2017-222338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A 20-year-old woman was brought to the surgery emergency department with the complaint of epigastric pain since 1 day following ingestion of multiple metallic nails with a cup full of toilet cleaner (corrosive acid) with a suicidal intention. Physical examination was essentially unremarkable, and the abdomen showed no signs of perforation peritonitis. X-rays of the abdomen showed multiple 'nail'-like radiopaque shadows in the abdominal cavity with no evidence of free gas under the domes of the diaphragm. A non-operative expectant management was pursued. The patient had passed all the sharps in stools without any complication and was discharged after 12 days. After 3 weeks, the patient presented with non-bilious vomiting. Further investigations revealed pyloric stenosis with no oesophageal luminal stenosis. To bypass the pyloric stenosis, a Billroth II gastrojejunostomy was performed. The postoperative period was uneventful, and the recovery was smooth.
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Affiliation(s)
- Manu Vats
- General Surgery, Maulana Azad Medical College, New Delhi, India
| | | | - Sushanto Neogi
- General Surgery, Maulana Azad Medical College, New Delhi, India
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Yao Q, Wu HP, Xiong B, Han P, Zheng CS. A new method of 3-dimensional localization of intraocular foreign bodies using CT imaging: A role of optic nerve. ACTA ACUST UNITED AC 2017; 37:110-114. [PMID: 28224428 DOI: 10.1007/s11596-017-1703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/16/2016] [Indexed: 10/18/2022]
Abstract
Computed tomography (CT) is considered the most sensitive method for the detection of intraocular foreign bodies (IOFBs). The purpose of this study was to evaluate a new method of 3-dimentional (3D) localization of IOFBs that takes advantage of the anatomical structure of the optic nerve and to assess the clinical outcomes using this new method. Twenty-two trauma patients with IOFBs or suspected IOFBs admitted to our hospital were scanned with multislice CT (MSCT) between July and December 2003. All scanning was performed with a 16-row spiral CT in axial plane using a sequential scanning protocol. During the scanning, the eyeball of the patient was kept stable and was not allowed to rotate internally or externally. Section collimation was set at 16 mm × 0.75 mm. Table feed was 12 mm. Reconstruction index was 0.75 mm. After scanning, the reconstructed images were loaded into a workstation to create the multiplanar reconstruction images with the aid of the 3D software. We compared the localization results with the operative findings. Multiplanar reconstruction images showed IOFBs in all 22 patients. IOFBs occurred in the eyeball of 14 patients, in the wall of the eyeball of 5 patients and in the posterior orbits of 3 patients. Different surgical procedures were designed according to the localization by this new method and all IOFBs were successfully removed. All of these foreign bodies were metallic and the localization of IOFB using MSCT was consistent with that found by operative findings. It was suggested that MSCT is a simple and effective imaging modality for the localization of IOFBs. In our study, we localized the IOFBs more quickly and accurately by taking advantage of the fixed position of the intraocular segment of the optic nerve, and determined the necessary surgical parameters.
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Affiliation(s)
- Qi Yao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Han-Ping Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chuan-Sheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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Park MS, Choi SY, Lee SM. Pigmented Mass in the Anterior Chamber Suspected of Granuloma Caused by a Metallic Foreign Body. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.2.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Seon Park
- Department of Ophthalmology, Hallym University Sacred Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sang Yul Choi
- Department of Ophthalmology, Korea Cancer Center Hospital, Seoul, Korea
| | - Sang-Mok Lee
- Department of Ophthalmology, Hallym University Sacred Hospital, Hallym University College of Medicine, Anyang, Korea
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Moon Y, Seo JW, Kang S, Sa HS. Clinical Characteristics of Intraorbital Foreign Bodies: Our Experience with 14 Cases. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.3.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yeji Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Won Seo
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sunah Kang
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Thatcher J, Chang YM, Chapman MN, Hovis K, Fujita A, Sobel R, Sakai O. Clinical-Radiologic Correlation of Extraocular Eye Movement Disorders: Seeing beneath the Surface. Radiographics 2016; 36:2123-2139. [PMID: 27831838 DOI: 10.1148/rg.2016150227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Extraocular eye movement disorders are relatively common and may be a significant source of discomfort and morbidity for patients. The presence of restricted eye movement can be detected clinically with quick, easily performed, noninvasive maneuvers that assess medial, lateral, upward, and downward gaze. However, detecting the presence of ocular dysmotility may not be sufficient to pinpoint the exact cause of eye restriction. Imaging plays an important role in excluding, in some cases, and detecting, in others, a specific cause responsible for the clinical presentation. However, the radiologist should be aware that the imaging findings in many of these conditions when taken in isolation from the clinical history and symptoms are often nonspecific. Normal eye movements are directly controlled by the ocular motor cranial nerves (CN III, IV, and VI) in coordination with indirect input or sensory stimuli derived from other cranial nerves. Specific causes of ocular dysmotility can be localized to the cranial nerve nuclei in the brainstem, the cranial nerve pathways in the peripheral nervous system, and the extraocular muscles in the orbit, with disease at any of these sites manifesting clinically as an eye movement disorder. A thorough understanding of central nervous system anatomy, cranial nerve pathways, and orbital anatomy, as well as familiarity with patterns of eye movement restriction, are necessary for accurate detection of radiologic abnormalities that support a diagnostic source of the suspected extraocular movement disorder. ©RSNA, 2016.
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Affiliation(s)
- Joshua Thatcher
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Yu-Ming Chang
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Margaret N Chapman
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Keegan Hovis
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Akifumi Fujita
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Rachel Sobel
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
| | - Osamu Sakai
- From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.)
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An investigation into the accuracy of orbital X-rays, when using CR, in detecting ferromagnetic intraocular foreign bodies. Radiography (Lond) 2016; 23:55-59. [PMID: 28290341 DOI: 10.1016/j.radi.2016.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/16/2016] [Accepted: 09/19/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of this study is to determine the accuracy of orbital X-rays, when using computed radiography (CR), in detecting ferromagnetic intra-ocular foreign bodies (IOFBs) prior to magnetic resonance imaging (MRI). METHODS A total of 64 orbital X-rays of an anthropomorphic head phantom were acquired using CR. For each image 1, 2, 3, or 4, large, medium, or small IOFBs were fixed to the anterior surface of the left or right orbit. Each of the acquired images with an IOFB was duplicated in order to increase the sample size. A further 16 normal images (no IOFB) were also included in the sample. Observers were invited to review the images and were permitted to manually magnify and window the images to detect any IOFBs present on each image. RESULTS 10 observers (4 radiographers; 4 reporting radiographers; 2 consultant radiologists) independently reviewed the images. The mean (SD) sensitivity and specificity were 72.1% (7.3%) and 99.2% (0.8%) for all observers, respectively. According to size the sensitivity in detecting small, medium and large IOFB were 46%, 76% and 93%, respectively. According to location, the lower lateral quadrants had the lowest sensitivity (53%) whereas the upper medial had the greatest (88%). CONCLUSION Findings from this study using CR support previous conclusions that conventional X-rays fail to detect metallic IOFBs in all cases. Diagnostic performance is governed by IOFB size and location.
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Loporchio D, Mukkamala L, Gorukanti K, Zarbin M, Langer P, Bhagat N. Intraocular foreign bodies: A review. Surv Ophthalmol 2016; 61:582-96. [PMID: 26994871 DOI: 10.1016/j.survophthal.2016.03.005] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/06/2016] [Accepted: 03/10/2016] [Indexed: 01/15/2023]
Abstract
Intraocular foreign body injuries may result in a wide range of intraocular pathology and visual outcomes based on the mechanism of injury, type of foreign body, and subsequent complications. We have reviewed the literature to describe the epidemiology and mechanisms of such injuries; types of foreign bodies; imaging tools for diagnosis; current trends in management, presurgical, and surgical interventions; as well as visual prognosis and potential complications. The purpose of this review is to familiarize clinicians with the recent advances in diagnosis and management of such injuries.
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Affiliation(s)
- Dean Loporchio
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Lekha Mukkamala
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Kavya Gorukanti
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Marco Zarbin
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Paul Langer
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey 07103, USA.
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Lockwood P, Pittock L, Lockwood C, Jeffery C, Piper K. Intraorbital foreign body detection and localisation by radiographers: A preliminary JAFROC observer performance study. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Imaging Foreign Bodies: Ingested, Aspirated, and Inserted. Ann Emerg Med 2015; 66:570-582.e5. [DOI: 10.1016/j.annemergmed.2015.07.499] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/07/2015] [Accepted: 07/15/2015] [Indexed: 12/27/2022]
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32
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Cuerpo extraño intraorbitario orgánico. Presentación de un caso clínico. REVISTA MEXICANA DE OFTALMOLOGÍA 2015. [DOI: 10.1016/j.mexoft.2015.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jhun P, Aguilera P, Swaminathan A, Bright A, Herbert M. Use Safety Glasses, Save an Eye…Enough Said. Ann Emerg Med 2015; 65:637-9. [DOI: 10.1016/j.annemergmed.2015.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chaudhary R, Upendran M, Campion N, Yeung A, Blanch R, Morgan-Warren P, Gibb I, Nelson T, Scott R. The role of computerised tomography in predicting visual outcome in ocular trauma patients. Eye (Lond) 2015; 29:867-71. [PMID: 25853401 DOI: 10.1038/eye.2015.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/09/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Ocular blast injuries in the military setting are particularly associated with significant maxillofacial trauma and/or brain injury. The opportunity to perform a comprehensive ophthalmic evaluation is frequently limited in the acute multiple trauma scenario. We aim to describe the relationship between the clinical effects of acute ocular and orbital blast trauma with the findings on computerised tomography (CT). METHODS This was a retrospective consecutive case series of all soldiers with facial and/or suspected ocular injuries. A total of 80 eyes that had suffered blast injuries of varying severity were studied. Assessment of orbital and ocular CT images were performed by military consultant radiologists. A comparison was made with actual clinical findings. Statistical analysis was performed using Fisher's exact test. RESULTS No pathological findings were described in 37 of the 80 eyes imaged by orbital and ocular CT scans. Clinically, these eyes and orbits were all found to be intact, or had minor trauma. All foreign bodies and penetrating eye injuries were successfully diagnosed by CT. Absence of an orbital fracture did not rule out a globe injury. However, a corneal or scleral defect was less likely when an orbital fracture was absent. CONCLUSION The eye is a delicate structure prone to injury that requires urgent repair if breached. It is difficult to assess thoroughly in the unconscious or distressed patient. In this context, CT imaging is invaluable to be able to make a relatively confident prediction of clinical findings and decide upon the necessity for acute ophthalmic surgical intervention.
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Affiliation(s)
- R Chaudhary
- Department of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham, UK
| | - M Upendran
- Department of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham, UK
| | - N Campion
- Section of Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - A Yeung
- Department of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham, UK
| | - R Blanch
- Section of Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - P Morgan-Warren
- Section of Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - I Gibb
- Fort Blockhouse, Defence Centre for Imaging, Gosport, UK
| | - T Nelson
- Royal Centre for Defence Medicine, New Queen Elizabeth Hospital, Birmingham, UK
| | - R Scott
- 1] Department of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham, UK [2] Royal Centre for Defence Medicine, New Queen Elizabeth Hospital, Birmingham, UK
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Sung EK, Nadgir RN, Fujita A, Siegel C, Ghafouri RH, Traband A, Sakai O. Injuries of the globe: what can the radiologist offer? Radiographics 2015; 34:764-76. [PMID: 24819794 DOI: 10.1148/rg.343135120] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Traumatic ocular injuries are a significant cause of blindness and visual deficits. In the setting of acute orbital trauma, urgent ophthalmologic evaluation and intervention are critical in preserving vision. However, in the acute trauma setting, clinical evaluation of the globe may be difficult in the presence of surrounding periorbital soft-tissue swelling and other associated injuries, and patient cooperation may be limited because of unresponsiveness, altered mentation, or sedation. Often, rapid access to imaging is part of the initial diagnostic evaluation, and radiologists may be the first to identify traumatic injuries of the globe. Because of this, radiologists should be familiar with normal orbital and globe anatomy at various imaging modalities and have a thorough understanding of the various patterns of ocular injury and their imaging appearances. Radiologists should also be familiar with the various mimics of ocular injury, including congenital and acquired conditions that may alter the shape of the globe, various types of ocular calcifications, and the different types of material used to treat retinal detachment. Such knowledge may help radiologists make accurate diagnoses, which facilitates prompt and appropriate patient care.
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Affiliation(s)
- Edward K Sung
- From the Departments of Radiology (E.K.S., R.N.N., A.F., C.S., O.S.), Ophthalmology (R.H.G., A.T.), and Otolaryngology-Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; and the Department of Radiology (A.F.), Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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Pinto A, Miele V, Pinto F, Mizio VD, Panico MR, Muzj C, Romano L. Rectal Foreign Bodies: Imaging Assessment and Medicolegal Aspects. Semin Ultrasound CT MR 2015; 36:88-93. [DOI: 10.1053/j.sult.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Reginelli A, Santagata M, Urraro F, Somma F, Izzo A, Cappabianca S, Rotondo A. Foreign bodies in the maxillofacial region: assessment with multidetector computed tomography. Semin Ultrasound CT MR 2014; 36:2-7. [PMID: 25639172 DOI: 10.1053/j.sult.2014.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Maxillofacial region is an anatomically complex area, representing a crossroads of different systems and apparatus. It is defined as the anatomical region lying on the facial skeleton from the inferior outline of maxilla up to an ideal plane passing through the skull base and the inion point, posteriorly. In this area, the digestive and respiratory systems connect to themselves and open in the mouth and sino-nasal cavities. Even the orbits with the ocular globes and their surrounding tissues lie in the same area. Despite the little exposed surface, the chance of penetrating injuries to this site is at least similar to other regions of the body due to the "pivotal role" of the face in human relations. Moreover, the external openings of respiratory and digestive systems and the orbital cavities represent an easy way in for foreign bodies (FBs). Based on the access paths, it is possible to distinguish ingested, inhaled, penetrating, and iatrogenic (owing to surgery) FBs. FB may stop in oral and ocular cavities, or proceed deeply, reaching the surrounding soft tissues, the facial bones, or other cavities such as sino-nasal region, mouth, orbits, and further spaces of the head and neck region, like infratemporal fossa, parapharyngeal space, and sphenopalatine fossa. Furthermore, FBs accidentally introduced and lost in visceral cavities (mouth, ear, and nose), particularly in pediatric subjects, may be quickly removed during direct inspection.
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Affiliation(s)
- Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy.
| | - Mario Santagata
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy
| | - Fabrizio Urraro
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | - Francesco Somma
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | - Andrea Izzo
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | - Salvatore Cappabianca
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | - Antonio Rotondo
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
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Pinto A, Lanza C, Pinto F, Grassi R, Romano L, Brunese L, Giovagnoni A. Role of plain radiography in the assessment of ingested foreign bodies in the pediatric patients. Semin Ultrasound CT MR 2014; 36:21-7. [PMID: 25639174 DOI: 10.1053/j.sult.2014.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ingestion of various types of foreign bodies (FBs) such as coins, toy parts, jewelry pieces, needles and pins, fish and chicken bones, and button-type batteries is common among children. The curiosity of children and their need to investigate the world around them place them at a higher risk for ingestion of FBs. Fortunately, 80%-90% of ingested foreign objects that reach the stomach will pass uneventfully without intervention. The remainder may become blocked in the esophagus or other region of the alimentary tract, placing the pediatric patient at risk of significant complications such as aspiration, obstruction, bleeding, perforation, fistulization, sepsis, and death. The goals of the initial pediatric patient assessment are to identify the type of object ingested, its location in the gastrointestinal tract, and the presence of associated complications. Factors reported to increase the risk of complications included a sharp FB, a FB with a wide diameter, and symptoms. Plain radiographs still play an important role in the assessment of ingested FBs in the pediatric patient: plain films of the neck, chest, and abdomen are very useful in confirming the diagnosis of FB ingestion because most ingested FBs are radiopaque.
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Affiliation(s)
- Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy.
| | - Cecilia Lanza
- Department of Radiology, Unit of General and Pediatric Radiology, University Politecnica delle Marche, Hospital Torrette-Lancisi-Salesi, Ancona, Italy
| | - Fabio Pinto
- Department of Diagnostic Radiological Imaging, Marcianise Hospital, Marcianise (CE), Italy
| | - Roberta Grassi
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Luigia Romano
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Luca Brunese
- Department of Health Science, University of Molise, Campobasso, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Unit of General and Pediatric Radiology, University Politecnica delle Marche, Hospital Torrette-Lancisi-Salesi, Ancona, Italy
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Reginelli A, Russo A, Pinto A, Stanzione F, Martiniello C, Cappabianca S, Brunese L, Squillaci E. The role of computed tomography in the preoperative assessment of gastrointestinal causes of acute abdomen in elderly patients. Int J Surg 2014; 12 Suppl 2:S181-S186. [DOI: 10.1016/j.ijsu.2014.08.345] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 01/19/2023]
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Abstract
Intraorbital foreign objects are common after high-velocity injuries and can result in disastrous consequences. A "trivial" facial injury may sometimes obscure the presence of an intraorbital foreign object. Difficulties in the approach to the intraconal space and possible surgical morbidity to the optic nerve make management especially challenging. We are reporting a case wherein an intraconal foreign body was missed during the initial examination of a maxillofacial injury and was subsequently successfully extracted by an endoscopic approach.
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Guerra G, Testa D, Montagnani S, Tafuri D, Salzano FA, Rocca A, Amato B, Salzano G, Dell'Aversana Orabona G, Piombino P, Motta G. Surgical management of pleomorphic adenoma of parotid gland in elderly patients: role of morphological features. Int J Surg 2014; 12 Suppl 2:S12-S16. [PMID: 25159550 DOI: 10.1016/j.ijsu.2014.08.391] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 12/11/2022]
Abstract
The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common form is the Pleomorphic adenoma (PA). Parotid gland is affected from 80% to 90% of cases. In elderly these tumors occur mostly in females. These benign tumors are composed of epithelial and myoepithelial cells that are arranged with various morphological patterns and subtypes. The classification of these tumors is also based on the amount and nature of the stroma. In literature there is an almost complete consensus that, in the major salivary glands, PAs are enclosed by a layer of fibrous tissue often called "capsule" but there is disagreement about the form, extension and thickness of this layer. The treatment is surgical and there are two main different surgical approaches: an enucleation (local dissection) or so-called subtotal superficial parotidectomy and lateral or superficial total parotidectomy. Histopathological characteristics of PAs especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration, satellite nodules and pseudopodia in the different subtypes are important for the choice of surgical treatment and the first explanation for tumor recurrence. In our study we describe a morphological features of 84 cases of pleomorphic adenoma of parotid gland from elderly patients treated by a surgical "enucleation like" method called nucleoresection.
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Affiliation(s)
- Germano Guerra
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
| | - Domenico Testa
- Department of Anesthesiologic, Surgical and Emergency Sciences, Otolaryngology, Head and Neck Surgery Unit, Second University of Naples, Italy.
| | - Stefania Montagnani
- Department of Public Health, University of Naples "Federico II", Naples, Italy.
| | - Domenico Tafuri
- Department of Sport Sciences and Wellness, University of Naples "Parthenope", Naples, Italy.
| | | | - Aldo Rocca
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - Giovanni Salzano
- Department of Neuroscience Reproductive and Dentistry Sciences, University of Naples "Federico II", Naples, Italy.
| | | | - Pasquale Piombino
- Department of Anesthesiologic, Surgical and Emergency Sciences, Otolaryngology, Head and Neck Surgery Unit, Second University of Naples, Italy.
| | - Gaetano Motta
- Department of Anesthesiologic, Surgical and Emergency Sciences, Otolaryngology, Head and Neck Surgery Unit, Second University of Naples, Italy.
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Chazen JL, Lantos J, Gupta A, Lelli GJ, Phillips CD. Orbital Soft-Tissue Trauma. Neuroimaging Clin N Am 2014; 24:425-37, vii. [DOI: 10.1016/j.nic.2014.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE To describe the characteristics of nail gun-related open-globe injuries. METHODS Retrospective series of all patients presenting with open globes secondary to nail gun injury from 2000 to 2010. Data were collected on demographics, setting of accident, presenting clinical examination findings, visual acuity, management, surgical procedures needed, and long-term outcomes. RESULTS Forty-two patients (43 eyes; mean age, 31.6 years; 100% male; 79% Hispanic) suffered open-globe injury from nail gun accidents. Thirty-seven eyes (86%) sustained injury at work. One of 15 (6.7%) patients, on whom data were available, wore protective eyewear during the incident. Entrance wounds were classified into Zone I (n = 24 [56%]), Zone II (n = 12 [28%]), and Zone III (n = 7 [16%]). Six eyes (14%) had retained intraocular foreign bodies. Mean presenting logarithm of the minimum angle of resolution visual acuity was 1.64 ± 0.83, whereas mean final logarithm of the minimum angle of resolution visual acuity was 1.01 ± 0.96 (P = 0.004). Two eyes (4.7%) had no light perception vision at final examination. Seventeen (40%) patients developed a traumatic cataract, and 2 (4.7%) had dislocated lens fragments. Most common findings on presentation included vitreous hemorrhage (n = 30 [70%]) and hyphema (n = 28 [64%]). Two eyes (4.7%) had a retinal detachment at presentation, and 10 (23%) developed a retinal detachment during follow-up visits. Anatomical success was observed in 11 eyes (92%) with a retinal detachment. Three eyes (7.0%) became phthisical or prephthisical, and 1 was enucleated for severe pain. No eyes developed endophthalmitis or sympathetic ophthalmia. CONCLUSION This is the largest compilation of nail gun-related open-globe injury reported to date. Posterior segment complications, noted in the majority of cases, likely contributed to the overall guarded visual outcomes. Preventative measures for eye protection should be strictly followed while using nail guns.
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OCULAR INJURIES WITH A METALLIC FOREIGN BODY IN THE POSTERIOR SEGMENT AS A RESULT OF HAMMERING. Retina 2014; 34:1116-22. [DOI: 10.1097/iae.0000000000000062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Betts AM, O'Brien WT, Davies BW, Youssef OH. A systematic approach to CT evaluation of orbital trauma. Emerg Radiol 2014; 21:511-31. [PMID: 24756375 DOI: 10.1007/s10140-014-1221-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/01/2014] [Indexed: 02/08/2023]
Abstract
Computed tomography (CT) is widely used in the initial evaluation of patients with craniofacial trauma. Due to anatomical proximity, craniofacial trauma often involves concomitant injury to the eye and orbit. These injuries may have devastating consequences to vision, ocular motility, and cosmesis. CT imaging provides a rapid and detailed evaluation of bony structures and soft tissues of the orbit, is sensitive in detection of orbital foreign bodies, and often guides clinical and surgical management decisions in orbital trauma. For this reason, radiologists should be prepared to rapidly recognize common orbital fracture patterns, accurately describe soft tissue injuries of the orbit, detect and localize retained foreign bodies within the globe and orbit, and recognize abnormalities of the contents and integrity of the globe. In this review, we present a systematic approach to assist radiologists in the rapid evaluation of orbital trauma using the "BALPINE" mnemonic-bones, anterior chamber, lens, posterior globe structures, intraconal orbit, neurovascular structures, and extraocular muscles/extraconal orbit. Using this approach, we describe common traumatic findings within each of these spaces, and present common postsurgical appearances that can mimic findings of acute trauma.
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Affiliation(s)
- Aaron M Betts
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St., Cincinnati, OH, 45267, USA,
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Callahan AB, Yoon MK. Intraorbital foreign bodies: retrospective chart review and review of literature. Int Ophthalmol Clin 2014; 53:157-65. [PMID: 24088942 DOI: 10.1097/iio.0b013e3182a12b55] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gordic S, Gerstl P, Brueesch M, Alkadhi H. It is not contrast media: CT imaging appearance of intra-arrest transnasal evaporative cooling. Am J Emerg Med 2013; 31:638.e5-6. [PMID: 23380112 DOI: 10.1016/j.ajem.2012.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 10/26/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sonja Gordic
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
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Abstract
This article shows the pathological and physiological images of the orbit, which each radiologist will commonly see in his or her everyday CT scan practice. It explains the images, following the course of the patient's trajectory through imaging as complications develop or in the post-treatment monitoring of some common disorders (orbital trauma, retinal detachment, postoperative appearances).
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Affiliation(s)
- F Héran
- Imaging Department, A de Rothschild Foundation, Paris, France.
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