Plain film, CT and MRI sensibility in the evaluation of intraorbital foreign bodies in an in vitro model of the orbit and in pig eyes

Dynamic computed tomography manifestations of simulated wooden foreign bodies in blood-saline mixtures with variable concentrations and retention times

Diagnosing wooden foreign bodies (WFBs) using computed tomography (CT) is often missed, leading to adverse outcomes. This study aims to reduce misdiagnoses by exploring the density variation of blood-saline mixtures in ex vivo models. Twenty Cunninghamia lanceolata sticks, selected as WFB models, were randomly assigned to five groups: a control group (saline) and four experimental groups immersed in blood-saline mixtures with varying concentrations. The samples were then placed in a constant-temperature water bath at 36.8 °C. CT scans were performed in the lowest and highest density areas, and the volume of the low-density areas was measured at the post-processing workstation. Finally, the effects of time and concentration on imaging were analyzed, and fitting curves were generated. The blood-saline mixture concentration and time significantly affected the CT number in the three areas. WFB images changed dynamically over time, with two typical imaging signs: the bull's-eye sign on the short axis images and the tram line sign on the long axis images. Fitting curves of the CT number in the lowest density areas with different concentrations can quantify imaging changes. The CT number of the lowest density areas increased with time, following a logarithmic function type, while the CT number of the highest density areas exhibited a fast-rising platform type. The volume of the low-density areas decreased over time. The time of damage caused by WFBs and the influence of varying blood and tissue fluid contents at the damaged site should be considered in the diagnosis. Imaging changes from multiple CT scans at different times can aid in diagnosis.

Plastic orbital foreign body: the rise of plastic and its unintended consequences

Intraorbital foreign bodies (IOrFBs) are a significant cause of ocular morbidity. Although plastic IOrFBs are rare, the increasing use of plastic and polymer composites in motor vehicles will increase their prevalence. Although challenging to identify, plastic IOrFBs have unique radiographic characteristics. The authors describe a case of an 18-year-old man with a history of a motor vehicle accident and a left upper eyelid laceration. In retrospect, imaging suggested a plastic IOrFB, which was initially overlooked. A follow-up examination demonstrated persistent left upper lid ptosis with an underlying mass. Further work-up revealed a retained IOrFB, which was removed via anterior orbitotomy. Scanning electron microscopy of the material was consistent with a plastic polymer. This case demonstrates the importance of maintaining a high suspicion for IOrFBs in the correct clinical context, the need for increased awareness of plastic and polymer composite IOrFBs, and the use of diagnostic imaging for identification.

Nuances in detecting retained foreign bodies: a case report of a glass shard embedded in a child's scalp

Foreign bodies (FBs) are a relatively common reason for admission to the emergency department, with subacutely embedded FBs presenting a diagnostic challenge to physicians. Retained FBs may cause the patient harm and result in litigation when missed. Diagnostic imaging is a powerful tool for localization of FBs and a physician's choice of modality should reflect its anticipated composition. This case report pertains to a 2-year-old boy with a glass shard embedded in his retro auricular scalp who presented with a painful subcutaneous lesion months after an overlying laceration repair at an outside emergency room. The attending neurosurgeon was able to identify a glass shard both on physical examination and axial T2-weighted MRI. Surgical exploration resulted in the removal of a 1-cm square glass shard. Key to the diagnostic potential of imaging is knowledge of a patient's relevant medical history and the composition of the suspected FB. Herein, we describe imaging modalities and their utility in the context of retained glass FBs.

Intraorbital wooden foreign body, legacy of a notorious scrap: a case report

Wooden foreign bodies are notorious to be fragile and get retained as bits and bobs in the orbit. A 50-year-old woman presented to casualty with complaints of loss of vision and pain in the right eye associated with discharge from a wound in right eye upper lid. On imaging, a wooden foreign body was seen as continuous track of air. Meticulous dissection and search were done to remove bits and bobs of the wood. Patient, however, after 15 days of primary surgery reported with pus collection over wound site. Keeping suspicion of remnant wooden body piece(s), imaging and further exploration were carried out, removal of a 1 cm residual wooden piece was done. Retained wooden foreign body should always be suspected in postoperative cases of intraorbital wooden foreign body with infection. A close follow-up and knowledge of the same stay useful to remove any needless apprehension both of patient and surgeon.

Bilateral iPhone Gorilla Glass Intraocular Foreign Bodies in a Pediatric Patient

A 13-year old male presented with bilateral intraocular foreign bodies (IOFBs) after a bullet struck his iPhone. The right eye vision was 20/50 and examination disclosed a limbal entry wound at 6:00, dense traumatic cataract, and vitreous hemorrhage. The left eye was 20/40 and an entry wound located roughly 4mm posterior to the limbus was noted. Fundoscopy revealed multiple refractile particles with pre-retinal and vitreous hemorrhage. CT scan demonstrated hyperdensities in the vitreous cavity bilaterally. Globe closure, cataract removal, vitrectomy, and endolaser were undertaken in the right eye, while only globe closure was performed in the left eye. On latest follow-up, the patient had 20/20 corrected vision without inflammation bilaterally. This case highlights challenges associated with the management of IOFBs of unknown material in a pediatric patient. A conservative approach led to full visual recovery, despite retained intraocular smartphone Gorilla glass.

Ocular porcupine quilling in dogs: Gross, clinical and histopathologic findings in 17 cases (1986-2018)

The objectives of this retrospective study were to evaluate the histopathologic changes associated with porcupine ocular quill injuries in dogs, to discuss the various methods of quill detection when quills are not grossly visible, and to discuss the pathogenesis of delayed ocular quill injuries in dogs. Seventeen globes sustaining ocular quilling injuries from 17 dogs (1986-2018) were identified in the COPLOW archives and the gross and histologic changes tabulated and compared. All cases were dogs, with one whole globe submitted from each patient. Sixteen of 17 cases had known or suspected porcupine encounters in the weeks or years preceding enucleation. Histopathologic findings included retinal detachment, hyphema, cataract, granulomatous to pyogranulomatous inflammation (uveitis, endophthalmitis, panophthalmitis), lens capsule rupture, suppurative phakitis, scleral perforation, stromal keratitis, breaks in Descemet's membrane, preiridal fibrovascular membrane, anterior and posterior synechia, Schnabel's cavernous atrophy, and periorbital fibrosis. Quill-associated ocular trauma can have a significant deleterious effect on vision and result in enucleation. The time from initial quilling to the manifestation of ocular signs may be prolonged (weeks to years). Any dog presenting for ocular signs with a history of a previous porcupine encounter should be carefully checked for quill migration into the globe as the source of ocular disease. Quills may not be visible grossly, and ancillary imaging techniques can be utilized with various rates of success.

CT more accurately detects foreign bodies within the equine foot than MRI or digital radiography

Identification and characterization of foreign bodies in the distal limb of horses poses a diagnostic challenge. The aims of this prospective experimental cadaver study were to describe the appearance of five foreign body materials within the equine hoof using CT, MRI, and digital radiography (DR) and to compare interrater agreement among three reviewers. Fifty foreign bodies consisting of five materials were implanted at a solar location or a coronary location in 25 equine cadaver feet. The images were reviewed by three equine veterinarians experienced in advanced imaging interpretation, who were blinded to the material of the foreign body. Foreign bodies were graded on visibility and appearance. Sensitivity and specificity were calculated for accurate identification of the different materials. Interrater agreement was assessed using Fleiss' kappa. Computed tomography had higher visibility score, sensitivity/specificity, and interrater agreement for detection of all materials; particularly slate, glass, and dry wood, compared to the other imaging modalities. Soaked wood and plastic had lower sensitivity (31-33%) on CT with a similar attenuation of the two materials. Foreign bodies were often visible on MRI, although with similar appearance and unclear details. On DR, only slate and glass were visible. The interrater agreement for identifying the correct material was almost perfect for slate, glass, and dry wood (κ = 0.92-1.00) and poor for plastic and soaked wood (κ < 0.20) on CT. Interrater agreement was poor for all materials on MRI and DR (κ < 0.20), with the except for fair (κ = 0.28) for slate on DR and moderate (κ = 0.28) for soaked wood on MRI.

Multimodal imaging features of intraocular foreign bodies

Objective: To determine the imaging approach for evaluating intraocular foreign bodies (IOFBs) by comparing the ability of different modalities [plain film x-ray, computed tomography (CT), magnetic resonsance imaging (MRI), convetional ultrasound, and ultrasound biomicroscopy] to detect and characterize IOFBs.Methods & Design: Systematic review of the literature.Results: CT is the most practical first step for evaluating patients with suspected IOFBs because it can detect a wide range of IOFB types at small limitis of detection. MRI and ultrasound are best reserved as adjunctive tests in most cases although these tests may provide important insights especially with wood, plastic, and glass IOFBs. Imaging characteristics of metal, wood, glass, plastic, stone, concrete, and graphite IOFBs are reviewed.Conclusion: Understanding the limits of detection for each IOFB type and imaging modality as well as the characteristic features of different IOFBs is of paramount importance to optimizing the management of ocular trauma patients.

Limitation of Computed Tomography in Identifying Intranasal Porcupine Quills in a Dog (Canis lupus familiaris)

A 6 yr old, spayed female, Rhodesian ridgeback was presented for a 6-8 wk history of serous nasal discharge after being quilled by a porcupine. Physical exam revealed mid dorsal maxilla sensitivity. Computed tomography showed a normal nasal cavity. Rhinoscopy revealed three porcupine quills which were removed from the nasal cavities. The patient's clinical signs had improved dramatically at 1 wk follow-up. This case demonstrates the limitations of computed tomography for diagnosing intranasal porcupine quills and the importance of pursuing rhinoscopy in patients with clinical signs of nasal disease.

Delayed diagnosis of an intraorbital wooden foreign body

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.

Visibility of Different Intraorbital Foreign Bodies Using Plain Radiography, Computed Tomography, Magnetic Resonance Imaging, and Cone-Beam Computed Tomography: An in Vitro Study

Purpose

The study sought to compare the usefulness of 4 imaging modalities in visualizing various intraorbital foreign bodies (IOFBs) in different sizes.

Methods

Six different materials including metal, wood, plastic, stone, glass. and graphite were cut in cylindrical shapes in 4 sizes (dimensions: 0.5, 1, 2, and 3 mm) and placed intraorbitally in the extraocular space of fresh sheep's head. Four skilled radiologists rated the visibility of the objects individually using plain radiography, spiral computed tomography (CT), magnetic resonance imaging (MRI), and cone-beam computed tomography (CBCT) in accordance with a previously described grading system.

Results

Excluding wood, all embedded foreign bodies were best visualized in CT and CBCT images with almost equal accuracies. Wood could only be detected using MRI, and then only when fragments were more than 2 mm in size. There were 3 false-positive MRI reports, suggesting air bubbles as wood IOFBs.

Conclusions

Because of lower cost and using less radiation in comparison with conventional CT, CBCT can be used as the initial imaging technique in cases with suspected IOFBs. Optimal imaging technique for wood IOFBs is yet to be defined.

Comparison of Ultrasonography, Magnetic Resonance Imaging and Cone Beam Computed Tomography for Detection of Foreign Bodies in Maxillofacial Region

INTRODUCTION

Foreign Bodies (FBs) entrapped in the maxillofacial region have a high prevalence due to trauma and accidents. Accurate localization of FBs and verifying their type and size are critical to assist the surgeon in their fast retrieval with minimal tissue damage.

AIM

To assess and compare the imaging modalities including MRI, ultrasonography and Cone Beam Computed Tomography (CBCT) for detection of different types of FBs.

MATERIALS AND METHODS

In this study, four types of FBs including pieces of normal glass, barium glass, wood and pebbles with equal sizes were placed randomly in two sheep heads in different locations such as upper lip, maxillary sinus and body of mandible as FBs and subjected to MRI, ultrasound and CBCT. The images were interpreted by expert observers and the data was analysed using the stata 11 software, kappa test and chi-square test.

RESULTS

Sensitivity of CBCT, MRI and ultrasound for detecting foreign bodies was 79.19%, 20.83% and 33.33%, respectively. None of the imaging modalities could clearly visualize wooden FBs. Among different FBs, pebbles and barium glass were detected more accurately by radiographic imaging technique. The sensitivity of CBCT, ultrasound and MRI for pebbles was 100%, 33.33% and 16.67%, respectively. The sensitivity of CBCT, ultrasound and MRI for barium glass was 100%, 33.33% and 41.69%, respectively. The sensitivity of CBCT, ultrasound and MRI for wood was 33.33%, 33.33% and 16.67%, respectively. Specificity of all three imaging modalities was 100%. Diagnostic accuracy of all three imaging modalities was higher for detection of FBs in the upper lip than those in the body of mandible, and FBs in the latter location had higher detection accuracy than those in the maxillary sinus.

CONCLUSION

Among the three imaging modalities, CBCT had the highest diagnostic sensitivity for the examined FBs. The highest diagnostic sensitivity was noted for pebbles and barium glass.

Intraocular foreign bodies: A review

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.

Visibility of different foreign bodies in the maxillofacial region using plain radiography, CT, MRI and ultrasonography: an in vitro study

OBJECTIVES

To compare the usefulness of four imaging modalities in visualizing various foreign bodies of different sizes.

METHODS

Foreign bodies of four sizes (0.5, 1, 2 and 3 mm) including metal, tooth, wood, plastic, stone, glass and graphite were embedded in six fresh sheep heads on bone surface between the corpus mandible and muscle, and inside the tongue muscle. A human dry skull served as an air-filled space. Plain radiography, CT, MRI and ultrasonography were used, and four skilled radiologists rated the findings individually.

RESULTS

All embedded foreign bodies except wood were best visualized using CT. Wood could only be detected using ultrasonography, and then only when fragments were >0.5 mm in size. Plain radiography and CT were almost equally accurate in visualizing metal and graphite. MRI was the least useful imaging technique.

CONCLUSIONS

In cases with suspected foreign bodies in the maxillofacial region, CT seems to be the optimal initial imaging study. Wood, however, could only be detected using ultrasonography.

Diamagnetic susceptibility artifact associated with graphite foreign body of the orbit

Imaging in traumatic injury to the orbits plays an important role to identify malformation of the globe, retrobulbar pathology, such as hematoma, the presence of fractures, and identification of foreign bodies. MRI can be especially useful in characterizing soft tissue abnormalities without the use of ionizing radiation. The authors report a case of penetrating injury to the orbit with a retained foreign body where the graphite core of a pencil ("pencil lead") resulted in metal-like diamagnetic susceptibility artifact. This was proven to have no metallic components by CT and surgical exploration. MRI performed in the setting of penetrating injury could aid in localization of a graphite foreign body, and if there is a known graphite foreign body, evaluation of immediately adjacent structures may be obscured.

Wooden intraorbital foreign body injuries: clinical characteristics and outcomes of 23 patients

PURPOSE

To describe the clinical characteristics, interventions, and visual outcomes of orbital injuries associated with wooden foreign bodies.

METHODS

A retrospective case review of orbital injuries managed at Wills Eye Institute and Massachusetts Eye and Ear Infirmary was conducted between 1992 and 2006.

RESULTS

The clinical course and management for a total of 23 intraorbital wooden foreign body injuries were reviewed. The distribution of wood included pencil (39%), tree branch/plant matter (35%), and other treated wood (26%). About half of the subjects (52%) presented with preoperative vision between 20/20 and 20/40. Almost all [corrected] of the subjects with preoperative vision between 20/20 to 20/40 retained vision in that range postoperatively (92%). [corrected] Time from injury to presentation was highly variable, ranging from 24 hours to 17 months (mean, 62 days; median, 3 days). Forty-three percent of subjects presented within 24 hours of injury. The site of foreign body found within the orbit was superior (26%; n = 6), medial 30% (n = 7), inferior (26%, n = 6), posterior (9%; n = 2), and lateral (4%; n = 1). Preliminary radiographic interpretation for foreign body was definite in 61% (n = 14), possible in 22% (n = 5), and absent in 13% (n = 3).

CONCLUSIONS

Young men are at particularly high risk for wood intraorbital foreign body. There was a relatively equal distribution of wood type. The time from injury to presentation was variable, ranging from <1 day to over a year. Almost half of the subjects presented within 24 hours of injury. In patients with a known site of penetration, almost half occurred in the conjunctiva, notably without presence of eyelid laceration, emphasizing the need to check the conjunctiva and fornices closely. Preliminary radiographic readings often miss or are inconclusive in detecting the foreign body. The shape, location, serial examinations, and particularly the use of quantitative CT are extremely helpful in distinguishing retained wood foreign body from other low-density signals of air or fat.

Comparison of the sensitivity for detecting foreign bodies among conventional plain radiography, computed tomography and ultrasonography

OBJECTIVE

The purpose of this study was to compare the sensitivity for detecting foreign bodies among conventional plain radiography, CT and ultrasonography in in vitro models.

METHODS

Seven different materials were selected as foreign bodies with dimensions of approximately 1 x 1 x 0.1 cm. These materials were metal, glass, wood, stone, acrylic, graphite and Bakelite. These foreign bodies were placed into a sheep's head between the corpus mandible and muscle, in the tongue and in the maxillary sinus. Conventional plain radiography, CT and ultrasonography imaging methods were compared to investigate their sensitivity for detecting these foreign bodies.

RESULTS

Metal, glass and stone can be detected with all the visualization techniques used in the study in all of the zones. In contrast to this, foreign bodies with low radiopacity, which could be detected in air with CT, became less visible or almost invisible in muscle tissue and between bone and muscle tissue. The performance of ultrasonography for visualizing foreign bodies with low radiopacity is relatively better than CT.

CONCLUSIONS

Ultrasonography detects and localizes superficial foreign bodies with low radiopacity in the tissues of the body more effectively than CT and conventional plain radiography. However, CT is a more effective technique for visualization of foreign bodies in air than ultrasound and conventional plain radiography.

Atypical presentation of an impacted radiolucent esophageal foreign body

Patients with impacted esophageal foreign bodies usually present with gastrointestinal and rarely with respiratory symptoms. Impacted esophageal foreign bodies may be identified by radiologic studies. Ingested radiolucent foreign bodies may be more difficult to diagnose, especially if the patient presents with minimal symptoms. We report a rare case of a child who presented with stridor and obstructive sleep apnea. The cause of respiratory symptoms was thought to be due to enlarged tonsils and adenoids, and the patient was scheduled for tonsillectomy and adenoidectomy. On re-evaluation by the surgeon on the day of surgery, the procedure was changed to diagnostic microlaryngoscopy and bronchoscopy to rule out any other cause. The patient's respiratory symptoms were resolved when an incidental discovery and retrieval of the radiolucent esophageal foreign body was made. The diagnosis of radiolucent esophageal foreign body can be difficult and can be easily missed without reasonable clinical suspicion.

Intraorbital wooden foreign body (IOFB): mimicking air on CT

We report the case of a 41-year-old man who presented to the ER following a fall in his back garden during which he sustained a left orbital injury. Computed tomography (CT) demonstrated an intraorbital linear lucency surrounded by haziness in the intraconal fat. An intraocular wooden twig was confirmed during subsequent surgery. The possibility of a wooden intraorbital foreign body should be strongly suspected following orbital trauma when there is intraorbital density below that of the surrounding intraorbital fat on CT, as this may mimic organic foreign bodies.

An intraorbital wooden foreign body: description of a case and a variety of CT appearances

We present a case report in which a 4-year-old girl was involved in a fall that resulted in an injury of the right orbita. The girl kept a chopstick in her right hand that got into the right orbita due to this accident. Only a fraction remained in the orbita; the residual chopstick got lost. Hence, the substance of the chopstick was unknown. Computed tomography (CT) revealed a foreign body in the right orbita, but ophthalmologists had initially no indication of intervention. Further course according to the follow-up CT showed an increase of Hounsfield units (HU). These findings led to the assumption that the foreign body was made of wood. Through this, the ophthalmologists performed an evacuation. Motivated by these clinical results, we created an experimental setup that could demonstrate changes of HU in different coated chopsticks. It is concluded that wooden foreign bodies can display a variety of CT appearances depending on materials, types, coating, and time-course.

Intralenticular intraocular foreign body after stone impact: CT and US findings

INTRODUCTION

Intraocular foreign body (IOFB) is a relatively common entity in emergency departments worldwide. Appropriate ocular assessment is mandatory if an intraocular foreign body is suspected because it is associated with an increased risk of endophtalmitis and a wide range of complications including hyphaema, cataract, vitreous hemorrhage, and retinal tears and detachment.

CASE REPORT

We present a case of intralenticular intraocular foreign body after stone impact.

DISCUSSION

Ultrasonography (US) and computed tomography (CT) show an accurate location of the foreign body inside the lens. This finding enabled the surgeon to perform a phacoemulsification lens extraction with removal of the foreign body, the optimal method of removing intralenticular IOFB. To our knowledge, this is the first US and CT imaging report.

Treatment of scattered glass foreign bodies in both the superficial and deep neck: A case report

There have not been any reports about scattered glass foreign bodies in the neck, while injuries of the head and neck region as a result of traffic accidents have been frequently reported. We report the case of a 17-year-old male injured in a traffic accident, with scattered glass foreign bodies in both the superficial and deep neck. A CT scan indicated the existence of numerous glass foreign bodies in the various layers of the neck. Most of the foreign bodies were very fine or sand-like. The wounded skin was keloidal and expected to lead to remarkable facial edema of the left side. The foreign bodies and cervical keloidal lesions with small pieces of glass were carefully removed, and then reconstruction was conducted in stages using tissue expanders. The facial edema was reversed and the aesthetic reconstruction satisfied the patient.

Detection of foreign bodies of the head with digital volume tomography

OBJECTIVES

Foreign bodies occur as a sequela of trauma or therapeutic interventions. If the risks are not too high, therapy of choice is the removal of the foreign body. This is only possible if the existence of a foreign body is detected and it is localized accurately.

METHODS

The suitability of digital volume tomography (DVT) for the detection and localization of foreign bodies was investigated. Samples of various materials that are typically found as foreign bodies in the head and neck region were used.

RESULTS

All materials investigated are principally detectable with DVT. Highly radiopaque material was detectable down to small sizes. The detectability of less radiopaque substances like wood and resins was poor when located in soft tissue.

CONCLUSION

DVT is an appropriate tool for the detection of radiopaque foreign bodies. However, foreign bodies made of wood and resin, although detectable by DVT, can be missed when located in muscular tissue. The detectability decreases further when the foreign body is located adjacent to a highly radiopaque tissue like bone. This has to be taken into consideration when using DVT for foreign body detection.