Value of 3-dimensional CT virtual anatomy imaging in complex foreign body retrieval from soft tissues

Augmented reality in forensics and forensic medicine - Current status and future prospects

Forensic investigations require a vast variety of knowledge and expertise of each specialist involved. With the increase in digitization and advanced technical possibilities, the traditional use of a computer with a screen for visualization and a mouse and keyboard for interactions has limitations, especially when visualizing the content in relation to the real world. Augmented reality (AR) can be used in such instances to support investigators in various tasks at the scene as well as later in the investigation process. In this article, we present current applications of AR in forensics and forensic medicine, the technological basics of AR, and the advantages that AR brings for forensic investigations. Furthermore, we will have a brief look at other fields of application and at future developments of AR in forensics.

A Pictorial Review of Radiologic Findings of Foreign Bodies in the Thorax

Thoracic foreign bodies (FBs) are serious and relatively frequent in emergency departments. Thoracic FBs may occur in association with aspiration, ingestion, trauma, or iatrogenic causes. Imaging plays an important role in the identification of FBs and their dimensions, structures, and locations, before the initiation of interventional treatment. To guide proper clinical management, radiologists should be aware of the radiologic presentations and the consequences of thoracic FBs. In this pictorial essay, we reviewed the optimal imaging settings to identify FBs in the thorax, classified thoracic FBs into four types according to their etiology, and reviewed the characteristic imaging features and the possible complications.

Retained haemodialysis-catheter guidewire in the head and neck: a multidisciplinary team approach

Penetrating foreign body in the head and neck can be catastrophic from injury to the constellation of vascular and neural structures in the neck. Early recognition and prompt surgical intervention is imperative to save lives. Herein, we present an unusual case of iatrogenic foreign body-a coiled guidewire embedded in the deep neck space. The complications, radiological investigation and multidisciplinary surgical management are further discussed.

CT-guided mapping in the removal of an impalpable, radiopaque foreign body in subcutaneous tissue: a case report

Small fragments sometimes penetrate the soft tissue, and their depth and location can be difficult to determine accurately. This case study describes localisation of a thin, short wire that had penetrated the soft tissue of a 24-year-old man's back, using computed tomography (CT) with a reference grid made with an angiographic catheter. The axial non-contrast-enhanced CT scan with the grid placed over the affected body part surveyed by the CT scout view showed that the foreign body was buried in fascia 7cm from a puncture wound. Surgical removal of the foreign body was then performed without any sequelae. CT with the use of external references that do not cause metal artefacts is a simple and helpful procedure in localising radiopaque foreign bodies.

Cobbler's Awl Causing a Rare Pediatric Paraspinal Injury Managed Using 3D CT

Pediatric spinal injuries are very uncommon, accounting for a small percentage of all spinal injuries. Domestic accidents such as falling and bumping are frequent events during childhood. In this case report, we present a rare penetrating trauma by a cobbler’s awl at the paraspinal level. The patient was referred to the ED after a needle became impaled into his back due to an accident that occurred at home. The patient’s neurologic assessment was normal. A radiologic study of the patient showed a cobbler’s awl penetrating the paravertebral muscle at the fourth lumbar vertebra level. The needle was removed promptly after an emergency surgical procedure. Postprocedure no complications occurred.

Percutaneous Retrieval of Foreign Bodies Around Vital Vessels Aided with Vascular Intervention: A Technical Note

OBJECTIVE

To describe a new interventional technique to remove foreign bodies (FBs) embedded in soft tissues around vital vessels.

METHODS

Under fluoroscopic guidance and using local anesthesia, percutaneous removal of FBs was performed using forceps in nine patients. All patients suffered from a metallic soft tissue FB located in close proximity to important vessels and one also had a small traumatic pseudoaneurysm adjacent to the FB. Prior to removal of the FB, the position of the nearest vessel was identified using a guide wire or catheter placed into the vessel. Balloon catheter was also simultaneously used to temporarily stop the blood flow of the nearest artery during the FB removal in three of the nine patients.

RESULTS

All of the nine FBs with 0-2 mm interval to the nearest vessel were successfully removed in the nine patients without any serious complications. The removed FBs measured 3-12 mm in length and 1-3 mm in width. The total fluoroscopic time of retrieval of each FB was 5-9 min (mean, 6.4 min). The volume of intraoperative bleeding ranged from 5 to 12 ml (mean, 7.5 ml). The length of hospital stay for each patient ranged from 4 to 8 days (mean, 5.5 days).

CONCLUSION

Vascular intervention-aided percutaneous FB removal is minimally invasive and an effective method for removal of FBs around vital vessels.

Metallic foreign body deep in the prevertebral space after an endomyocardial biopsy: a case report

Introduction

Although inspirated or ingested foreign bodies constitute a common otolaryngologic emergency, the removal of a solitary retained foreign body from the neck has seldom been described in the literature. The ingestion of foreign bodies commonly results in perforated viscose or extraluminal migration to adjacent structures quite a long period of time after the fact. To the best of our knowledge, this is the first English language description of an endomyocardial biopsy complicated by a retained foreign body deep in the prevertebral space of the patient’s neck. We report such a case and share our experience in treating it.

Case presentation

A 68-year-old Asian man suffering right-sided heart failure underwent an endomyocardial biopsy via his right internal jugular vein. After undergoing the procedure, he was found to have retained a metallic cup tip which had become lodged in his neck. A surgeon then performed neck exploration and the foreign body was removed without adverse effect.

Conclusions

Decision making as to whether to remove the foreign body or not remains controversial. However, the later incidence of adhesive fibrosis or, even worse, of a catastrophic abscess or adjacent vascular injury might occur if the foreign body was not removed. Early exploration is suggested, if the patient’s condition makes this feasible.