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Zhao H, Feng H, Du L. Diagnosis and treatment intraorbital foreign body: A case report. Clin Case Rep 2024; 12:e8733. [PMID: 38689682 PMCID: PMC11060878 DOI: 10.1002/ccr3.8733] [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] [Received: 12/07/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 05/02/2024] Open
Abstract
Key Clinical Message Wooden foreign bodies inside the eye socket are an uncommon kind of eye injury that falls into a distinct category of intraorbital foreign bodies. Due to the wide range of clinical presentations and imaging features of intraorbital wooden foreign bodies, misinterpretation and failure to diagnose correctly often happen. Abstract Wooden foreign bodies inside the eye socket are an uncommon kind of eye injury that falls into a distinct category of intraorbital foreign bodies. The condition mostly manifested in individuals of youthful and middle age. Due to the wide range of clinical presentations and imaging features of intraorbital wooden foreign bodies, misinterpretation and failure to diagnose correctly often happen during the first examination. The risk of orbital infection might greatly rise if there is a delay in diagnosing woody foreign substances inside the eye socket. The majority of patients need surgical intervention as the recommended course of therapy. Nevertheless, it is essential to avoid disregarding undetected diagnoses and the existence of foreign material remnants after prior surgical procedures. Hence, achieving a precise diagnosis relies on a comprehensive assessment of the patient's trauma history, meticulous examination of the eyes, vigilant monitoring of clinical symptoms, accurate imaging techniques such as magnetic resonance imaging (MRI) or computerized tomography (CT), and prompt and thorough removal of wooden foreign objects within the eye socket.
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Affiliation(s)
- Hongqing Zhao
- Nanbu County People's HospitalNanchongSichuan ProvinceChina
- 77th Army HospitalLeshanSichuan ProvinceChina
| | - Hui Feng
- 77th Army HospitalLeshanSichuan ProvinceChina
| | - Lei Du
- 77th Army HospitalLeshanSichuan ProvinceChina
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Sandridge B, Palazzolo M, Faulk D, Mandler T. Improving ferromagnetic screenings before MRI in pediatric patients. Paediatr Anaesth 2023; 33:872-873. [PMID: 37218450 DOI: 10.1111/pan.14701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Affiliation(s)
| | | | - Debra Faulk
- Children's Hospital Colorado, Aurora, Colorado, USA
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Yogev D, Lev-Tzion R, Ledder O, Orlanski-Meyer E, Zharkov E, Cytter-Kuint R. Retained metal fragments following esophageal button battery impaction. Eur J Pediatr 2022; 181:143-147. [PMID: 34223968 DOI: 10.1007/s00431-021-04184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
Button battery (BB) impaction in the esophagus requires immediate endoscopic removal and meticulous follow-up, including serial cross-sectional imaging, preferably with magnetic resonance imaging (MRI). However, BBs quickly degrade in the esophagus, and metallic fragments may remain in the injured mucosa following removal. This metallic debris can cause thermal injury during MRI, potentially aggravating local injury. We aimed to explore whether such metallic fragments could be identified on imaging following BB removal. In this study, we conducted a retrospective review of children (0-18 years) presenting with BB impaction in the esophagus between 2014 and 2020. Endoscopy reports and imaging studies were blindly reviewed by a pediatric gastroenterologist and a pediatric radiologist. Of 161 cases of battery ingestion, 14 (8%) underwent endoscopy, and in 9 (5%) a BB was impacted in the esophagus. The median time from ingestion to BB removal was 8 h (range 2-48 h). The median time from removal to CT was 44 h (range 0.5-104 h). BB appearance ranged from mild corrosion to visible debris. Pre-removal plain films showed irregular battery contour suggesting corrosion (5/7 plain films). In 7/9 CT scans (78%), high-attenuation esophageal content (median 266HU (range 140-1151)), which may represent metallic debris, was identified. Five patients had a follow-up CT which still showed gradual resolution of the high-attenuation content.Conclusions: we describe a new finding on CT following BB removal which might represent metallic debris. Clinicians should be aware of these findings which potentially may be harmful during MRI used in the ongoing assessment of esophageal injury. What is Known: • Button batteries are a dangerous pediatric foreign body with potentially fatal vascular complications. What is New: • Metallic debris was identified on computerized tomography following button battery removal in most children. • We bring to attention this new finding which may affect clinical management, as minimal metallic content can cause burns during MRI.
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Affiliation(s)
- Dotan Yogev
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raffi Lev-Tzion
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Oren Ledder
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esther Orlanski-Meyer
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Elena Zharkov
- Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ruth Cytter-Kuint
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. .,Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel.
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Glover NM, Roten R. Gastric Perforation During MRI After Ingestion of Ferromagnetic Foreign Bodies. Clin Pract Cases Emerg Med 2021; 5:362-364. [PMID: 34437049 PMCID: PMC8373193 DOI: 10.5811/cpcem.2021.4.52307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/23/2021] [Indexed: 11/11/2022] Open
Abstract
CASE PRESENTATION A 65-year-old male with schizophrenia and intellectual disability ingested what was reported to be two AA batteries, prior to a scheduled magnetic resonance imaging (MRI) study. He developed severe abdominal pain and presented to the emergency department the following day with hypovolemic/septic shock. General surgery retrieved two metal sockets and a clevis pin from the stomach prior to surgical repair of a gastric perforation. This case highlights a rare yet critical outcome of ingesting ferromagnetic foreign bodies prior to an MRI study. DISCUSSION Medical literature on this subject is scarce as indwelling metal foreign bodies are a contraindication to obtaining an MRI. Yet some patients with indwelling metallic foreign bodies proceed with MRI studies due to either challenges in communication such as age, psychiatric/mental debility, or unknowingly having an indwelling metal foreign body. In this case, the patient surreptitiously ingested metal objects prior to obtaining an MRI.
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Affiliation(s)
- Nicholas M Glover
- Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California
| | - Ryan Roten
- Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California
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Jungesblut OD, Berger-Groch J, Meenen NM, Stuecker R, Rupprecht M. Validity of Ultrasound Compared with Magnetic Resonance Imaging in Evaluation of Osteochondritis Dissecans of the Distal Femur in Children. Cartilage 2021; 12:169-174. [PMID: 30704293 PMCID: PMC7970372 DOI: 10.1177/1947603519828434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is currently the gold standard to diagnose and monitor osteochondritis dissecans (OCD) of the knee. The purpose of this study was to evaluate for the first time if ultrasound imaging can be used to visualize osteochondritis dissecans of the distal femur. DESIGN From May 2008 to December 2013, 44 children (26 boys and 18 girls) presenting with OCD of the knee in our department were examined and evaluated by ultrasound imaging. Mean age at diagnosis was 11.8 ± 2.2 years. Two independent experienced orthopedic surgeons analyzed the localization, stage, and the size of the OCD via ultrasound and compared the results with the MRI findings. RESULTS Ultrasonic examination has limitations in assessing the OCD stage I and therefore is not suitable for evaluating this stage of the disease. In stages II to IV, a good correlation to MRI regarding defect localization and size can be found, when the defect is localized in a region that is accessible to ultrasonic examination. CONCLUSION Ultrasonic scan is an appropriate tool for the screening and monitoring of OCDs stages II to IV. It provides an inexpensive and readily available alternative to MRI. In addition, the healing process of higher grade defects as well as the screening of the opposite side can also be performed by ultrasound. Detection of defects being localized close to the intercondylar notch or far posterior on the lateral condyle are limitations for the use of ultrasound.
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Affiliation(s)
- Oliver D. Jungesblut
- Department of Pediatric
Orthopedics, Altona Children’s Hospital, Hamburg, Germany,Department of Orthopedics,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josephine Berger-Groch
- Department of Pediatric
Orthopedics, Altona Children’s Hospital, Hamburg, Germany,Department of Trauma-, Hand- and
Reconstructive Surgery, University Medical Center Hamburg-Eppendorf,
Hamburg, Germany,Josephine Berger-Groch, Department
of Trauma-, Hand-, and Reconstructive Surgery, University Hospital
Hamburg Eppendorf, Martinistraße 52, Hamburg, D-20246, Germany.
| | - Norbert M. Meenen
- Department of Pediatric
Orthopedics, Altona Children’s Hospital, Hamburg, Germany,Pediatric Sports Medicine,
Surgical Traumatological Center, Asklepios St. Georg Clinic, Hamburg,
Germany
| | - Ralf Stuecker
- Department of Pediatric
Orthopedics, Altona Children’s Hospital, Hamburg, Germany,Department of Orthopedics,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Rupprecht
- Department of Pediatric
Orthopedics, Altona Children’s Hospital, Hamburg, Germany,Department of Orthopedics,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Oyewole B, Sandhya A, Maheswaran I, Campbell-Smith T. Lockdown dilemma: ingestion of magnetic beads presenting as right iliac fossa pain and subacute small bowel obstruction. BMJ Case Rep 2020; 13:13/11/e236429. [PMID: 33148596 DOI: 10.1136/bcr-2020-236429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 13-year-old girl presented with a 3-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She presented again 6 days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment. Intraoperative findings revealed 200 mL of serous fluid in the pelvis, normal-looking appendix, dilated stomach and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.
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Affiliation(s)
- Bankole Oyewole
- General Surgery, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Anu Sandhya
- General Surgery, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Ian Maheswaran
- General Surgery, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
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Bayramoğlu SE, Sayın N, Erdogan M, Yıldız Ekinci D, Uzunlulu N, Bayramoglu Z. Delayed diagnosis of an intraorbital wooden foreign body. Orbit 2018; 37:468-471. [PMID: 29469678 DOI: 10.1080/01676830.2018.1440606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/10/2018] [Indexed: 06/08/2023]
Abstract
A 35-year-old male patient was presented with pain on his right upper eyelid. A piece of wood injured his orbital and supraorbital regions while working at a furniture factory 10 days prior to our hospital admission. It was learned that the patient was discharged following the primary would closure procedure. Subsequent to the craniofacial computed tomography, primary wound closure was performed in the emergency room of previous hospital. In our clinic, a skin suturing on the nasal side of the right eyebrow was inspected and a foreign body (FB) was palpated on the superonasal contiguity of the patients' right globe. A hyperdense FB measuring 30 × 10 × 5 mm in size with smooth margins on superonasal contour of the globe was detected. Superonasal orbitotomy was performed and the FB was completely removed. Finally, visual acuity was 20/20 and a mild residual ptosis was observed.
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Affiliation(s)
- Sadık Etka Bayramoğlu
- a Opthtalmology Department Istanbul , Kanuni Sultan Suleyman Training and Research Hospital , Turkey
| | - Nihat Sayın
- a Opthtalmology Department Istanbul , Kanuni Sultan Suleyman Training and Research Hospital , Turkey
| | - Mehmet Erdogan
- a Opthtalmology Department Istanbul , Kanuni Sultan Suleyman Training and Research Hospital , Turkey
| | - Dilbade Yıldız Ekinci
- a Opthtalmology Department Istanbul , Kanuni Sultan Suleyman Training and Research Hospital , Turkey
| | - Nail Uzunlulu
- b Radiology Department , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey
| | - Zuhal Bayramoglu
- c Istanbul Medicine Faculty, Radiology Department , Istanbul University , Istanbul , Turkey
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Abstract
PURPOSE The intraorbital wooden foreign body is often misdiagnosed or missed on computed tomog- raphy (CT) scan, due to the invisible or unclear images. The residual foreign bodies often occur during surgical removal. The clinical manifestations, imaging features and treatment of intraorbital wooden foreign bodies were discussed in this study. METHOD We retrospectively analyzed 14 cases of intraorbital wooden foreign bodies managed at our hospital between January 2007 and May 2015. All patients underwent orbital CT examination before surgery, and surgery was performed under general anesthesia with orbital wound debridement and suture, as well as exploration and removal of wooden foreign bodies. RESULTS At first, 11 cases underwent removal of foreign bodies, including 1 case with incomplete removal and then receiving a secondary surgery. Foreign bodies were not found in three cases with preoperative misdiagnosis and orbital MRI found residual foreign bodies in the orbit. Operations were performed via primary wound approach in eight cases, conjunctival approach in two cases, and anterior orbitotomy in four cases. Postoperatively, one case was complicated with eye injuries, three cases with ocular muscle injuries, eight cases with visual loss, and eight cases with orbital abscess. The length of foreign bodies ranged from 1.8 cm to 11.0 cm. The maximum of four foreign bodies were removed at the same time. CONCLUSION Because the imaging of orbital wooden foreign bodies is complex and varied, MRI should be combined when they are invisible on CT scan. At the same time injuries trajectory and clinical mani- festations of patients should be taken into account. Surgical exploration should be extensive and thor- ough, and foreign bodies and orbital abscess must be cleared.
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Yamamoto K, Nakayama Y, Yamamoto I, Matsusue Y, Shimotsuji H, Kirita T. A Ferromagnetic Foreign Body at the Lateral Aspect of the Mandibular Ramus in a Medically Compromised Patient. Open Dent J 2016; 10:390-4. [PMID: 27583049 PMCID: PMC4988091 DOI: 10.2174/1874210616021001390] [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] [Received: 10/18/2015] [Revised: 06/06/2016] [Accepted: 06/24/2016] [Indexed: 11/22/2022] Open
Abstract
A case of a ferromagnetic foreign body in a medically compromised patient was reported. The patient was a 45-year-old male who consulted our department complaining of a foreign body accidentally impacted in the right cheek. X-ray examination revealed a foreign body at the lateral aspect of the right mandibular ramus. The removal of the foreign body was scheduled, but the patient did not return for the procedure. After 8 years he revisited our department for the removal of the foreign body, because it had been found to be ferromagnetic and a barrier to MRI examination. X-ray examination confirmed the foreign body was located at the same site as 8 years prior. Although the patient was suffering from liver cirrhosis with thrombocytopenia and leukopenia, the foreign body was successfully removed under general anesthesia. The foreign body was 12 × 5 × 1 mm, weighed 0.48 g, and was ferromagnetic. The patient’s postoperative course was uneventful. X-ray examination confirmed the removal of the foreign body. Since the surgery, the patient has been in generally stable condition with no complications. This case was a rare example of a foreign body that needed to be removed for medical examination.
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Affiliation(s)
- K Yamamoto
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Y Nakayama
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - I Yamamoto
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Y Matsusue
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - H Shimotsuji
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - T Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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Weidman EK, Dean KE, Rivera W, Loftus ML, Stokes TW, Min RJ. MRI safety: a report of current practice and advancements in patient preparation and screening. Clin Imaging 2015; 39:935-7. [PMID: 26422769 DOI: 10.1016/j.clinimag.2015.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022]
Abstract
MRI offers detailed diagnostic images without ionizing radiation; however, there are considerable safety concerns associated with high electromagnetic field strength. With increasing use of high and ultra high (7T) magnetic field strength, adequate patient preparation and screening for ferrous material is increasingly important. We review current safety standards for patient screening and preparation and how they are implemented at our institution. In addition, we describe a novel supplemental screening technique wherein the lights are dimmed in response to detected ferrous metal at the threshold of Zone IV.
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Affiliation(s)
- Elizabeth K Weidman
- Department of Radiology, NewYork-Presbyterian Weill Cornell, 525 E. 68th St, New York, NY 10065
| | - Kathryn E Dean
- Department of Radiology, NewYork-Presbyterian Weill Cornell, 525 E. 68th St, New York, NY 10065
| | - William Rivera
- Weill Cornell Imaging at NewYork-Presbyterian, 520 East 70th Street, New York, NY 10021
| | - Michael L Loftus
- Department of Radiology, NewYork-Presbyterian Weill Cornell, 525 E. 68th St, New York, NY 10065
| | - Thomas W Stokes
- Weill Cornell Imaging at NewYork-Presbyterian, 520 East 70th Street, New York, NY 10021
| | - Robert J Min
- Department of Radiology, NewYork-Presbyterian Weill Cornell, 525 E. 68th St, New York, NY 10065; Weill Cornell Imaging at NewYork-Presbyterian, 520 East 70th Street, New York, NY 10021.
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