Unveiling a foreign body masquerading as periarticular calcification: a case report.

INTRODUCTION: Evaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often underlie occult pathologies, benign symptoms are frequently miscategorized as idiopathic. CASE PRESENTATION: We present a case of retained glass obscuring as acute calcific periarthritis on imaging. A 48-year-old White male with vague fifth metacarpophalangeal joint pain had unrevealing exams, but radiographs showed periarticular calcification concerning inflammation. Surgical exploration unexpectedly revealed an encapsulated glass fragment eroding bone. Further history uncovered a forgotten glass laceration decade prior. The foreign body was removed, resolving symptoms. DISCUSSION: This case reveals two imperative diagnostic principles for nonspecific extremity pain: (1) advanced imaging lacks specificity to differentiate inflammatory arthropathies from alternate intra-articular processes such as foreign bodies, and (2) obscure patient history questions unearth causal subtleties that direct accurate diagnosis. Though initial scans suggested acute calcific periarthritis, exhaustive revisiting of the patient's subtle decade-old glass cut proved pivotal in illuminating the underlying driver of symptoms. CONCLUSION: Our findings underscore the critical limitations of imaging and the vital role that meticulous history-taking plays in clarifying ambiguous chronic limb presentations. They spotlight the imperative of probing even distant trauma when symptoms seem disconnected from causative events. This case reinforces the comprehensive evaluation of all subtle patient clues as key in illuminating elusive extremity pain etiologies.

Chronic jejuno-colonic fistula and intestinal malabsorption due to multiple magnet ingestions: A case report and systematic review.

Magnet ingestion in children can lead to serious complications, both acutely and chronically. This case report discusses the treatment approach for a case involving multiple magnet ingestions, which resulted in a jejuno-colonic fistula, segmental intestinal volvulus, hepa-tosteatosis, and renal calculus detected at a late stage. Additionally, we conducted a literature review to explore the characteristics of intestinal fistulas caused by magnet ingestion. A six-year-old girl was admitted to the Pediatric Gastroenterology Department pre-senting with intermittent abdominal pain, vomiting, and diarrhea persisting for two years. Initial differential diagnoses included celiac disease, cystic fibrosis, inflammatory bowel disease, and tuberculosis, yet the etiology remained elusive. The Pediatric Surgery team was consulted after a jejuno-colonic fistula was suspected based on magnetic resonance imaging findings. The physical examination revealed no signs of acute abdomen but showed mild abdominal distension. Subsequent upper gastrointestinal series and contrast enema graphy confirmed a jejuno-colonic fistula and segmental volvulus. The family later reported that the child had swallowed a magnet two years prior, and medical follow-up had stopped after the spontaneous expulsion of the magnets within one to two weeks. Surgical intervention was necessary to correct the volvulus and repair the large jejuno-colonic fistula. To identify relevant studies, we conducted a detailed literature search on magnet ingestion and gastrointestinal fistulas according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We identified 44 articles encompassing 55 cases where symptoms did not manifest in the acute phase and acute abdomen was not observed. In 29 cases, the time of magnet ingestion was unknown. Among the 26 cases with a known ingestion time, the average duration until fistula detection was 22.8 days (range: 1-90 days). Fistula repairs were performed via laparotomy in 47 cases.

Clinical characteristics and removal approaches of tracheal and bronchial foreign bodies in elders.

The symptoms of tracheobronchial foreign body in the elderly are not typical, so they are often missed or misdiagnosed. This study aims to depict the clinical characteristics of tracheobronchial foreign body inhalation in the elderly. We retrospectively analysed the clinical data of elder patients (age ≥ 65 years) diagnosed with tracheal and bronchial foreign bodies. The data included age, sex, clinical symptoms, type and location of foreign bodies, prehospital duration, Chest CT, bronchoscopic findings, and frequencies and tools for removing these elderly patients' tracheal and bronchial foreign bodies. All patients were followed up for a half year. Fifty-nine cases were included, of which only 32.2% had a definite aspiration history. Disease duration > 30 days accounted for 27.1% of the patients. 27.1% of the patients had a history of stroke, and 23.8% had Alzheimer's Disease. Regarding clinical symptoms, patients mainly experience cough and expectoration. The most common CT findings were abnormal density shadow (37.3%) and pulmonary infiltration (22.0%). Under bronchoscopy, purulent secretions were observed in 52.5% of patients, and granulation tissue hyperplasia was observed in 45.8%. Food (55.9%) was the most common foreign object, including seafood shells (5.1%), bones (20.3%), dentures (18.6%), and tablets (20.3%). The success rate of foreign body removal under a bronchoscope was 96.7%, 28.8% of the foreign bodies were on the left and 69.5% on the right. 5.1% of the elderly patients required rigid bronchoscopy, and 6.8% required two bronchoscopies. In elderly cohorts, tracheal foreign bodies are obscured by nonspecific clinical presentations and a paucity of aspiration history, challenging timely diagnosis. Predominantly constituted by food particles, with a notable predilection for the left bronchial tree, these cases demand skilled bronchoscopic management, occasionally requiring sophisticated approaches for successful extraction.

Chronic stridor in a toddler after ingestion of a discharged button battery: a case report.

BACKGROUND: Button battery (BB) ingestions (BBI) are increasingly prevalent in children and constitute a significant, potentially life-threatening health hazard, and thus a pediatric emergency. Ingested BBs are usually charged and can cause severe symptom within 2 h. Discharged BBs ingestion is very rare and protracted symptom trajectories complicate diagnosis. Timely imaging is all the more important. Discharged BBs pose specific hazards, such as impaction, and necessitate additional interventions. CASE PRESENTATION: We present the case of a previously healthy 19-month-old girl who was admitted to our pediatric university clinic in Germany for assessment of a three-month history of intermittent, mainly inspiratory stridor, snoring and feeding problems (swallowing, crying at the sight of food). The child's physical examination and vital signs were normal. Common infectious causes, such as bronchitis, were ruled out by normal lab results including normal infection parameters, negative serology for common respiratory viruses, and normal blood gas analysis, the absence of fever or pathological auscultation findings. The patient's history contained no evidence of an ingestion or aspiration event, no other red flags (e.g., traveling, contact to TBC). Considering this and with bronchoscopy being the gold standard for foreign body (FB) detection, an x-ray was initially deferred. A diagnostic bronchoscopy, performed to check for airway pathologies, revealed normal mucosal and anatomic findings, but a non-pulsatile bulge in the trachea. Subsequent esophagoscopy showed an undefined FB, lodged in the upper third of the otherwise intact esophagus. The FB was identified as a BB by a chest X-ray. Retrieval of the battery proved extremely difficult due to its wedged position and prolonged ingestion and required a two-stage procedure with consultation of Ear Nose Throat colleagues. Recurring stenosis and regurgitation required one-time esophageal bougienage during follow-up examinations. Since then, the child has been asymptomatic in the biannual endoscopic controls and is thriving satisfactorily. CONCLUSION: This case describes the rare and unusual case of a long-term ingested, discharged BB. It underscores the need for heightened vigilance among healthcare providers regarding the potential hazards posed by discharged BBIs in otherwise healthy children with newly, unexplained stridor and feeding problems. This case emphasizes the critical role of early diagnostic imaging and interdisciplinary interventions in ensuring timely management and preventing long-term complications associated even to discharged BBs.

Ingestion of heated tobacco sticks containing a micro-blade by children: the importance of performing a radiograph.

INTRODUCTION: Some tobacco sticks, such as TEREA™ heat sticks for IQOS ILUMA™, contain a blade. Both the nicotine part of the device and the micro-blade can be ingested by children. CASE SUMMARIES: We report two children, an 18-month-old boy and a 10-month-old girl, who ingested a heat stick containing a micro-blade. IMAGES: Radiography revealed the micro-blade to be in the child's mouth in the first case and the stomach in the second. Endoscopy was performed on the second child, confirming the presence of the blade in the stomach. CONCLUSION: We recommend performing a radiograph on all children who ingest tobacco sticks containing a micro-blade. If a metallic object is present, we recommend endoscopic removal to avoid traumatic lesions from the sharp edges.

Value of multiplanar reconstruction in multi-slice computed tomography for the detection of foreign body in the pulmonary artery: a case report.

Multi-slice computed tomography (MSCT) is the primary method for the detection and visualization of foreign bodies in the pulmonary artery because it provides high sensitivity and accuracy. It is very difficult to diagnose a patient with a non-iatrogenic pulmonary artery foreign body who does not have a history of a penetrating trauma. This case report describes a 36-year-old male that presented with coughing and haemoptysis. Based on conventional coronal and cross-sectional CT, the foreign body was misdiagnosed as pulmonary tuberculosis and pulmonary artery thrombosis. During treatment of the bronchial artery embolization and anti-tuberculosis therapy, the patient continued to experience haemoptysis. After further analysis of the pulmonary artery CT angiography images and curved multiplane reconstruction, an approximately 6-cm long toothpick was identified in the pulmonary artery with an unclear entry route. After surgery to remove the toothpick, symptoms of coughing and haemoptysis were resolved. This current case demonstrated that multiplane reconstruction in MSCT can improve the detection and visualization of pulmonary artery foreign bodies, which can aid in the diagnosis of pulmonary artery diseases of unknown cause.

Foreign body aspiration in children: our pediatric tertiary care experience.

PURPOSE: Inhalation of a foreign body is a real emergency in pediatric age and requires prompt diagnosis and treatment to reduce mortality. The objective of this study is to analyze clinical and radiological details, types, and localization of foreign bodies in patients conducted or to our hospital with suspected inhalation. METHODS: We conducted a retrospective analysis of all cases of foreign body inhalation admitted to our Pediatric Emergency Room between January 2009 and June 2022. RESULTS: 171 patients were included in the study. In 83 patients, the FB was detected. The mean age of presentation was 2.3 years (SD: ± 2). Cough (73%) and unilateral reduced breath sound (51%) were the most common clinical symptom and clinical sign. The most frequent localization was the right main bronchus (43%). The foreign bodies retrieved were vegetable (83%), of which peanut was the most common. Chest radiographs were normal in 25%. The mean duration of hospitalization was 5 days (± 2.9). Complications such as pneumothorax were seen in two cases. CONCLUSIONS: Foreign body inhalation represents a true pediatric emergency and still a challenge in clinical practice. The best way to manage it is an early diagnosis and removal by fully trained staff.

[Endovascular Repair of Aortic Injury Caused by Esophageal Foreign Body:Report of a Case].

A 51-year-old man visited to our hospital because of chest discomfort and hematemesis. He was diagnosed with Mallory-Weiss syndrome and followed in outpatient clinic. One week later, he visited our hospital again for fever and discomfort. Chest computed tomography (CT) showed a foreign body perforated in the mediastinum in the upper esophagus, and he was urgently hospitalized for surgical removal of esophageal foreign body. Before surgery he vomited the esophageal foreign body with a lot of blood. Hematemesis was stopped spontaneously and contrast-enhanced CT revealed a pseudoaneurysm in the distal aortic arch, so thoracic endovascular aortic repair (TEVAR) was performed to prevent rupture. Esophageal endoscopy found that the site of esophageal injury healed spontaneously, so the patient was followed conservatively with antibiotics. He was discharged on postoperative day 18 uneventfully. TEVAR was an effective treatment for aortic injury caused by esophageal foreign body in our case.

A 56-Year-Old Woman Presenting 19 Years After Pubic Bone Fracture with a Surgical Screw Foreign Body in the Bladder.

BACKGROUND Non-calculus foreign bodies in the bladder are rare and are usually introduced via the urethra. Reports of the migration of metallic foreign bodies from previous surgery are uncommon and mainly associated with surgical screws used for the internal fixation of pubic bone fracture and total hip replacement. This report is of a 56-year-old woman presenting with a surgical screw foreign body in the bladder 19 years after open surgical reduction and internal plate and screw fixation of traumatic fracture of the pubic bone. CASE REPORT A 56-year-old woman visited a urologist because of gross hematuria. She mentioned a mild pelvic pain and multiple lower urinary tract infections over the past 2 years, with no other symptoms. From the previous history, she had undergone an open reduction and internal fixation of the pelvic ring, with surgical plates and screws following pubic bone's fracture, due to an accident 19 years earlier. Cystoscopy identified the presence of a screw head protruding into the bladder wall. The screw was extracted via open surgery, and the patient was discharged 2 days later. CONCLUSIONS While intravesical foreign bodies are rarely seen in Emergency Departments, clinicians should maintain a level of suspicion in certain cases. The purpose of this case report is to present the unlikely and delayed complication of internal pubic bone fixation resulting in the migration of a fixation screw to the bladder. It also highlights the importance of imaging in diagnosis and localization of the foreign body in the bladder.

No cupid, just an arrow: a penetrating injury into the interventricular septum.

BACKGROUND: Penetrating cardiac injuries are rare but often fatal, with 16-55% mortality. We report a patient who suffered a non-fatal occupational cardiac injury. CASE PRESENTATION: A 47-year-old man was operating an ironworker machine. A thin 3-cm metal fragment catapulted from the machine piercing the chest wall and the right ventricular outflow tract (RVOT), burrowing into the interventricular septum (IVS). The patient remained hemodynamically stable and walked to the nearest hospital. ECG-gated computed tomography revealed the exact location of the fragment within the IVS, allowing for detailed preoperative planning. The fragment was removed through a sternotomy and an incision through the RVOT. The postoperative course was uneventful. CONCLUSIONS: This case underscores the value of detailed preoperative imaging and the wide spectrum of clinical scenarios of penetrating cardiac injuries.

Intrapulmonary migration of a fractured acupuncture needle: a case report.

BACKGROUND: Acupuncture, a traditional Chinese medical treatment, has been gaining popularity over the years. However, it also presents certain risks. We report a case of a patient who discovered a foreign body in their lung several years after undergoing acupuncture. CASE PRESENTATION: A middle-aged woman presented to our hospital with chest pain. An X-ray revealed a needle-like foreign body in the middle lobe of her right lung. The patient had previously undergone acupuncture treatment for local pain in her lower back and lower extremities many years prior. Based on the imaging findings and her medical history, we hypothesized that the foreign body in her lung was a result of a dislodged acupuncture needle. Through preoperative 3-dimensional reconstruction and indocyanine green localization, we were able to locate the foreign body in the lateral segment of the right middle lobe. We successfully removed the foreign body via wedge resection, and the patient made a smooth recovery post-surgery. CONCLUSION: Acupuncturists and surgeons should remain vigilant about the potential risks associated with acupuncture.

Gossypiboma mimicking hepatic hydatid cyst after 22 years: a case report.

Gossypiboma is a non-absorbable material that is forgotten during surgery. These are medicolegal pathology that leads to diagnostic confusion from abscess to tumor. We present the case of gossypiboma detected in laparotomy in a 57-year-old male patient who had a history of operation due to a hydatid cyst 22 years ago and was referred to our center due to hydatid recurrence. The case should suggest a history of surgical gossypiboma, especially in asymptomatic patients. In this preventable pathology, the strategy during sur-gery and the careful and proper attitude of the surgical team are the main determinants.

Clinical Validation of Computer-Aided Diagnosis Software for Preventing Retained Surgical Sponges.

BACKGROUND: We previously reported the successful development of a computer-aided diagnosis (CAD) system for preventing retained surgical sponges with deep learning using training data, including composite and simulated radiographs. In this study, we evaluated the efficacy of the CAD system in a clinical setting. STUDY DESIGN: A total of 1,053 postoperative radiographs obtained from patients 20 years of age or older who underwent surgery were evaluated. We implemented a foreign object detection application software on the portable radiographic device used in the operating room to detect retained surgical sponges. The results of the CAD system diagnosis were prospectively collected. RESULTS: Among the 1,053 images, the CAD system detected possible retained surgical items in 150 images. Specificity was 85.8%, which is similar to the data obtained during the development of the software. CONCLUSIONS: The validation of a CAD system using deep learning in a clinical setting showed similar efficacy as during the development of the system. These results suggest that the CAD system can contribute to the establishment of a more effective protocol than the current standard practice for preventing the retention of surgical items.

Imaging characteristics of incidentally detected cosmetic surgery-derived foreign bodies on CT images in the maxillofacial region.

OBJECTIVES: This study examined the imaging characteristics of cosmetic surgery-derived foreign bodies in the maxillofacial region through a retrospective review of cosmetic material foreign bodies incidentally detected on computed tomography (CT) images in routine clinical practice. METHODS: We retrospectively investigated cases of cosmetic surgery-derived foreign bodies other than dental materials in the maxillofacial region, using 5 years of CT image data stored on an imaging server. The imaging findings of these foreign bodies were investigated, along with patient age, patient sex, whether the foreign bodies were associated with the disease targeted by the CT scan, and the availability of cosmetic surgery information prior to examination. RESULTS: Foreign bodies were more common in women (19/21 cases), and affected patients displayed a wide age range (20-84 years). Four types of cosmetic surgery-derived foreign bodies in the maxillofacial region were detected by CT examination: nasal prostheses (nasal region), lifting sutures and injectable facial fillers (both in the buccal region), and silicone chin implants (chin region). CONCLUSIONS: A cosmetic surgery-derived foreign body should be suspected when a foreign body is identified without a dental source of infection. In addition, cosmetic surgery-derived foreign bodies may be present in numerous patients, regardless of age or sex.

Accidental ingestion of multiple magnetic beads by children and their impact on the gastrointestinal tract: a single-center study.

OBJECTIVE: In this study, we aimed to enhance the treatment protocols and help understand the harm caused by the accidental ingestion of magnetic beads by children. METHODS: Data were collected from 72 children with multiple gastrointestinal perforations or gastrointestinal obstructions. The 72 pediatric patients were divided into a perforation and a non-perforation group. The data collected for the analysis included the gender, age, medical history, place of residence (rural or urban), and symptoms along with the educational background of the caregiver, the location and quantity of any foreign bodies discovered during the procedure, whether perforation was confirmed during the procedure, and the number of times magnetic beads had been accidentally ingested. RESULTS: The accuracy rate of preoperative gastrointestinal perforation diagnosis via ultrasound was 71%, while that of the upright abdominal X-ray method was only 46%. In terms of symptoms, the risk of perforation was 13.844 and 12.703 times greater in pediatric patients who experienced vomiting and abdominal pain with vomiting and abdominal distension, respectively, compared to patients in an asymptomatic state. There were no statistical differences between the perforation and the non-perforation groups in terms of age, gender, medical history, and the number of magnetic beads ingested (P > 0.05); however, there were statistical differences in terms of white blood cell count (P = 0.048) and c-reactive protein levels (P = 0.033). A total of 56% of cases underwent a laparotomy along with perforation repair and 19% underwent gastroscopy along with laparotomy. All pediatric patients recovered without complications following surgery. CONCLUSION: Abdominal ultrasonography and/or upright abdominal X-ray analyses should be carried out as soon as possible in case of suspicion of accidental ingestion of magnetic beads by children. In most cases, immediate surgical intervention is required. Given the serious consequences of ingesting this type of foreign body, it is essential to inform parents and/or caregivers about the importance of preventing young children from using such products.

Radiographic grid for locating foreign bodies in maxillofacial emergency trauma.

OBJECTIVES: The accurate localization of the foreign bodies (FBs) is essential. This work presents a new noninvasive technique for subcutaneous metallic FBs under a radiographic grid, a system that simplifies the localization of facial FBs removal using a grid with embedded reference points. METHODS: This work designed a retrospective study to evaluate the effect of a radiographic grid on FBs removal surgery. All patients who met the inclusion criteria and attended the Hospital of Stomatology of China Medical University from January 2022 to June 2023 were enrolled and randomly divided into grid and non-grid groups. The assessment of facial swelling, the primary indicator, was conducted on days 2 and 7 post-surgery. The variables were analyzed using the Student t test and a repeated-measures general linear model. RESULTS: The study sample consisted of 20 patients, with 14 males (70%) and 6 females (30%), who had an average age of 30.30 ± 5.38. The average time of operation was 1.85 ± 0.66 h (range 0.7 to 3.2). In the present cases in this report, of the 20 patients' FBs, 14 were metal, 5 were glass, and 1 was residual root. And the FBs were surgically removed with no postoperative complications. Through comparison, it was found that the degree of swelling on day 2 postoperatively was significantly different between the grid group and the non-grid group (P < 0.05). CONCLUSIONS: This study demonstrates that a radiographic grid with mark points is a more efficient approach compared with traditional methods for FBs removal, and this surgical method is more accurate, fast and noninvasive.