Computed tomography of a cranial wooden foreign body

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.

Transnasal Penetration of a Ballpoint Pen: Case Report and Review of Literature

BACKGROUND

Transnasal penetration by a nonmissile foreign body is a rare injury. Consequently, appropriate management remains controversial. We report a case of transnasal penetration by a ballpoint pen and review the literature. To our knowledge, this is the first living patient who sustained carotid artery damage from a transnasal penetrating intracranial injury.

CASE DESCRIPTION

A 56-year-old female presented with a ballpoint pen lodged through her left nostril. She exhibited right cranial nerve palsies (III, IV, VI, and V1). A computed tomography (CT) scan of the head revealed a foreign body in the left nasal cavity traversing the ethmoid/sphenoid and likely through the right superior orbital fissure and cavernous sinus, with the distal tip adjacent to the right atrium. CT angiography revealed nonopacification of the right internal carotid artery (ICA) from the mid-petrous segment to the ophthalmic segment. Subsequently, she underwent coil embolization of the proximal right ICA, followed by a right frontotemporal craniotomy with anterior temporal lobectomy to skeletonize the pen and right distal ICA, and finally clipping of the ICA distal to the pen and prompt transnasal endoscopic removal of the pen. There were no hemorrhagic complications. She awoke at her neurologic preoperative baseline.

CONCLUSION

Injuries such as the one described here should be managed through a multidisciplinary approach. The trajectory of the foreign body should be delineated through CT imaging, along with vascular imaging if appropriate. If there are signs of vascular injury, then attempts to maintain proximal and distal control are prudent to avoid hemorrhagic complications. This combined endovascular-endoscopic-open craniotomy approach has not been reported previously in the literature.

Oro-cranial penetrating pencil injury

Oro-cranial penetrating injuries are often seen in ear, nose and throat practices. Cases of penetrated pencil injuries are rarely reported despite being common in the developing world. A 7-year-old boy referred from a neighboring hospital was playing at school with the sharp end of a pencil in his mouth when he was pushed from behind by another child. He fell on his face and the sharp end of the pencil penetrated his throat with the distal end hanging out. There was no bleeding at presentation, as the pencil completely sealed the entrance point. The entrance point was at the posterior wall of the oropharynx corresponding to the uvulo-palatine junction. It penetrated posterosuperiorly through the soft tissue to reach the anterior part of the posterior cranial fossa. Since sharp and pointed objects in the upper aerodigestive tract can result in potentially fatal complications, prompt diagnosis, a systematic treatment protocol, and an experienced trauma team are necessary to prevent a potential catastrophe.

Endoscopic treatment of transnasal intracranial penetrating foreign body

Transnasal intracranial penetrating injury is rare. We report a case of transnasal intracranial penetrating metallic chopstick, which was removed successfully by endoscopic approach, and management of transnasal intracranial penetrating injuries.

Transnasal bamboo foreign body lodged in the sphenoid sinus

Transnasal sphenoid sinus foreign body is a rare condition. We report a very rare case of transnasal bamboo foreign body lodged in the sphenoid sinus without damages to the orbital wall or skull base. A 69-year-old man fell down onto a bamboo stick, which snapped after penetrating his face through the right nostril. CT demonstrated that the bamboo stick stuck into the middle meatus, penetrated the ethmoid sinus just medial to the lamina papyracea and reached to the sphenoid sinus. No abnormal findings were detected in the orbit or skull base. The foreign body was removed from the nasal cavity without any complication. The endoscope was useful for evaluating possible injuries in the orbit and skull base and confirming the absence of residual foreign bodies.

Penetrating intracranial wooden object: case report and review of CT morphology, complications, and management

BACKGROUND

Penetrating intracranial wooden fragments after vehicular accidents are uncommon. The CT morphology, complications, and management in such cases are quite variable.

CASE REPORT

A 27-year-old male was seen with a "twig" from a tree embedded firmly just below the right medial canthus after a motorcycle accident. Diagnosis of intracranial penetrating wooden object was made on CT scanning. The wooden stick, which had splintered into two, was extricated through a craniotomy in two operative sessions. However the patient succumbed to septicemia and meningitis on the twelfth day after the accident.

CONCLUSIONS

The need for prompt extrication of these objects and the causes of high mortality in this condition are discussed. The importance of imaging the intracranial compartment in injuries involving the periorbital region is emphasized.

Penetrating orbital injury with organic foreign bodies

OBJECTIVE

The authors reviewed the clinical features, diagnostic workup, and management of patients of penetrating orbital injuries with retained organic foreign bodies.

DESIGN

Retrospective, noncomparative case series.

PARTICIPANTS

Nineteen patients (15 males, 4 females) with penetrating orbital injuries due to organic foreign bodies.

RESULTS

The series included 15 (78.9%) males and 4 (21.1%) females who ranged in age from 6 months to 40 years (mean = 14.6 years); 12 (63.2%) patients were younger than 12 years of age. Twelve (63.2%) right and 7 (36.8%) left orbits were involved. Time between injury and presentation varied from a few hours to 9 months. Most common injury site was the superior orbit in 11 (57.9%) patients leading to abnormal extraocular motility (84.2%), proptosis (68.4%), and upper lid ptosis (47.4%). Associated pathologies also included acute cellulitis in 11, orbitocutaneous fistula in 5, and osteomyelitis in 2 patients. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) identified the foreign bodies in 42% and 57% of the patients, respectively.

CONCLUSION

Preoperative identification of the foreign material in the orbit was found to be very helpful for patient management but was only possible in approximately 50% of our cases with the use of CT and MRI. The vision in our patients usually improved shortly after treatment; the long-term complications more often included extraocular muscle and eyelid motility problems and periorbital scarring.

An intracranial wooden foreign body without neurological findings: case report

We encountered an unusual case of an intracranial wooden stick penetrating through the frontal bone, without remarkable neurological findings. That foreign body was shown to be a low-density area similar to an intracranial air pocket by a standard computed tomogram. Here we discuss the potential hazards of intracranial wooden foreign bodies and emphasize the necessity for special attention to them during radiologic examination.

Chopstick penetration of the posterior cranial fossa: case report

A very rare case of wooden foreign body intrusion into the posterior cranial fossa is reported. The patient, a 16-month-old girl, fell down while holding chopsticks and was injured in the right pre-auricular region. Computed tomographic scans revealed a linear low-density area ranging from the right external auditory meatus to the fourth ventricle through the petrous portion of the temporal bone, passing near the middle cerebellar peduncle. Right temporal craniotomy was performed to abrade the petrous bone, resulting in removal of the chopstick fragment. The patient had an uneventful postoperative course and was discharged in ambulant condition, only with right hearing difficulty.

Wooden transnasal intracranial penetration: an unusual presentation

A 2 1/2-year-old child presented to the emergency department with a wooden stick lodged firmly in her right nares. No nasal discharge or neurological abnormalities were noted at presentation. After plain radiographs failed to demonstrate any evidence of a foreign body, computed tomography (CT scan) was obtained that revealed a hypodense region in the right frontal lobe corresponding to the projected tract of the branch. The patient underwent a right frontal craniotomy with debridement of her contused right frontal lobe. She was discharged 8 days postoperatively without evidence of neurologic sequelae. This case illustrates an unusual presentation of intracranial penetration, with only six similar cases found in the literature. It also highlights the need for the emergency physician to be concerned about intracranial penetration when treating intranasal foreign bodies, particularly those of the nonmetallic type. The literature is reviewed regarding transnasal intracranial penetration by wooden foreign bodies.

Penetrating intracranial wood wounds: clinical limitations of computerized tomography

The case history of a patient with a periorbital penetrating wooden foreign body is presented. The computerized tomography (CT) densities of several different sources of wood were compared using an experimental model. The clinical usefulness and practical limitations of CT in the evaluation of intracranial foreign bodies is discussed, and the management of this type of injury is reviewed.

Orthopedic grand rounds. Retained wooden foreign body in the foot detected by computed tomography

A 20-year-old female presented with a 12-week history of a penetrating wound by a pointed wooden slat to the dorsum of her right foot. She had persistent pain, swelling, and an open wound. Initial radiographs were normal, and three surgical explorations failed to find a foreign body. Later radiographs showed erosion of the second metatarsal. Computed tomography detected and localized the wooden foreign body. Removal of the foreign body was followed by healing of the foot.

Unusual craniocerebral penetrating injury by a chopstick

The case of a 53-year-old man who attempted suicide by introducing a wooden chopstick through his nostril into his brain is reported. The importance of computed tomography is stressed in the diagnosis of intracranial wooden foreign bodies.

Computed tomography in localization of foreign bodies lodged in the extremities

Surgical removal of foreign objects (FO) lodged in the body may be difficult because of uncertain 3-dimensional localization on conventional roentgenograms. Furthermore, low-density FO may not be detectable on roentgenograms. CT was performed in 8 patients with FO lodged in the extremities, and was found helpful because, (1) it detected 4 low-density FO's missed on roentgenograms, and (2) it facilitated surgical removal by displaying the precise 3-dimensional location of these objects.

Computed tomography in penetrating cranial injury by a wooden foreign body

We present a case in which the skull and brain were pierced by a piece of wood, the low attenuation value of which, in a CT scan, simulated an intracerebral pneumatocoele. The risk of misinterpreting the CT appearance of intracranial wood is discussed, and the importance of thorough exploration of a penetrating cranial injury is stressed.

CT in a case of intracranial penetration of a pencil. A case report

A case is reported of an unusual foreign body, a pencil, penetrating the right temporal lobe through the squamous temporal bone in a fall. Wood has low attenuation coefficients, so that the appropriate CT examination includes multiple window settings to permit accurate assessment of bone fragment displacement as well as recognition of detached wood splinters. CT scanning and early surgery are important steps in the management of these injuries to reduce significantly the overall mortality as well as immediate and long term complications. The necessity for meticulous surgical technique when removing the foreign body is stressed as retained wood can not easily be visualized against the hypodense background due to postoperative changes.

[Possibilities of locating foreign bodies by computed tomography]

Clinical and experimental examinations are described for the localization of intra-ocular and intra-orbital foreign bodies by CT scan. The minimal detectable diameter size was 0.2 X 0.3 mm for metal, and 0.5 mm for glass. We had difficulty in distinguishing wood from air bubbles, mainly in the retrobulbar space. First clinical results have shown CT-localization to be useful in cases where conventional X-ray techniques led to doubtful results.

Computed tomography of orbital trauma

Ten cases of trauma to the orbit and orbital region are presented to illustrate the efficacy of computed tomography in the radiologic evaluation of these injuries. CT was able to detect subarachnoid hemorrhage, retrobulbar hematoma, orbital cellulitis, foreign bodies, intraglobal and intraorbital air, dislocated lens, blowout, and tripod fractures in these patients.