Corpus alienum.
Award: Wiley-Blackwell Best Exhibit Award, Radiology
Poster No.: R-0030
Congress: 2017 ASM
Type: Educational Exhibit
Authors: S. Constantine, J. Buckley; SA/AU
Keywords: Emergency, Conventional radiography, CT, Ultrasound, Catheters,
Complications, Foreign bodies
DOI: 10.1594/ranzcr2017/R-0030
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Learning objectives
• To recognize the radiological appearances of various foreign bodies.
• To be aware of the complications of foreign bodies, especially if not
recognized and treated promptly.
Background
Corpus alienum or foreign body, refers to any object or piece of extraneous matter that
enters the body. This can be accidental or deliberate, and can be ingested, inserted
through a natural body orifice or introduced through a wound in the skin or mucous
membrane. We are all familiar with the shocking cases of large and impressive foreign
bodies some patients manage to acquire. Impalings with metal posts, nail gun accidents
and stabbings with swords can be found in the news reports and on the internet. Many
small and seemingly unimpressive foreign bodies can be just as deadly if not recognised,
removed and treated quickly. Examples include small fish bones, toothpicks and bread
tags, and the deadly button batteries that appeal to small children. Even iatrogenic
"foreign bodies" such as pacemakers and gastric bands can cause serious health issues.
Imaging findings OR Procedure details
This poster gives examples of the large to very small foreign bodies, and the radiological
signs that assist in making a rapid diagnosis of these potentially life threatening "corpora
aliena". Examples are also included of complications that can occur if these objects are
not rapidly removed.
Inhaled and Ingested Foreign Bodies
1. Inhaled radiolucent objects with air trapping
The large majority of inhaled foreign bodies are radiolucent, and not able to be seen on
chest x-ray. Items such as peanuts, corn kernels, diced vegetables such as raw carrot
and peas are easily inhaled by small children[1]. Presenting symptoms include wheezing,
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cough and dyspnoea. A frontal inspiratory chest x-ray is often normal (Fig. 1 on page
9). An expiratory view often shows air-trapping, indicating which side the inhaled
object is obstructing (Fig. 2 on page 9). Bronchoscopy may be required to remove
the offending object. This child inhaled a meatball that lodged in the left main bronchus.
2. Bread Tags (Fig. 3 on page 10)
There have been numerous reports of plastic bread-bag tags causing gastrointestinal
bleeding[2], obstruction[3-5], and even death[6]. They have been replaced by other ties
in some countries, but are still commonly used in Australia. Despite not being intended
for human consumption, it seems they are quite palatable to some individuals, but
can become snagged in the bowel causing pain, as in this first case, or even bowel
obstruction. This patient presented with 2 months of abdominal pain, and was referred
for a CT scan by his GP (Fig. 4 on page 11, Fig. 5 on page 12).
This bread tag was an incidental finding in this elderly female (Fig. 6 on page 13, Fig.
7 on page 14). It had been seen on more than one occasion over at least 18 months
and was not causing any symptoms.
3. Toothpick in Meckel's diverticulum
A Meckel's diverticulum can become a "trap" for foreign objects. There are numerous
reports in the literature of fish and chicken bones becoming lodged in this blind-ending
pouch[7, 8]. Perforation is a common sequela, as has occurred in this case. This man
presented with right iliac fossa pain and peritonism. The CT scan shows a linear foreign
body in the distal small bowel with local perforation (Fig. 8 on page 15). A wooden
toothpick was retrieved from a Meckel's diverticulum via laparotomy.
4. Bezoar
A bezoar is a mass of foreign material that becomes trapped in the digestive tract. The
subtypes seen most commonly in Western society is the trichobezoar, where the mass
consists primarily of hair. Other indigestible substances are frequently trapped within the
giant hairball, which can cause obstruction to the stomach or bowel. Trichobezoars are
most commonly seen in young girls who chew on their long hair (Fig. 9 on page 16,
Fig. 10 on page 18).
5. Worms
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Almost all children become infected with pinworms (Enterobius vermicularis) at some
point. These small thread-like parasites are transmitted by oro-faecal contamination, and
are often asymptomatic[9]. They are not infrequently seen in both the normal and inflamed
appendix on ultrasound scanning[10] (Fig. 11 on page 18).
Ascaris lumbricoides or the human roundworm is usually transmitted via contaminated
water[11]. Symptoms are usually non-specific, including abdominal pain, although
massive infection can result in bowel obstruction. Worms appear as filling defects on
barium studies. This CT scan in a male with increasing abdominal pain shows a worm
almost 30 cm long in the small bowel, with its own "barium follow through" of ingested
contrast (Fig. 12 on page 20).
6. Button Batteries
In our electronically-dependent society, our homes are filled with devices that use small
button batteries. Unfortunately, these small shiny objects are very tempting to young
children, and there are increasing numbers of reports of toddlers swallowing these lolly-
sized items (Fig. 13 on page 20, Fig. 14 on page 22). As the batteries corrode
in the GI tract, severe and life-threatening injuries can occur, including ulceration and
perforation of the oesophagus, stomach and bowel[12, 13]. There are also reports of
fistula formation between the oesophagus and trachea or aorta. These batteries can look
almost identical to coins on x-ray[14], and "2 views in 2 planes" should be performed if
there is any doubt. Prompt removal of the battery is needed to prevent corrosive injuries.
7. Fish and Chicken Bones
Ingested fish bones are one of the most common foreign bodies we encounter in adults,
yet they can be very difficult to identify due to their small size. Calcifications in the neck,
especially the laryngeal cartilages make visualisation on plain film unreliable, and we
often need to rely on secondary signs of impaction, including soft tissue swelling or gas in
the retropharyngeal tissues indicating perforation[15]. CT scanning provides much better
resolution, although these tiny bones can still be very subtle. This patient presented with
a fishbone stuck in his throat. No bone could be seen on plain x-ray (Fig. 15 on page
22). Endoscopy had seen soft tissue swelling with blood and pus in the right vallecular,
but could not see the bone. CT provided accurate localisation (Fig. 16 on page 24,
Fig. 17 on page 24).
Chicken bones can be just as difficult to see, especially if they are in the abdomen.
Identifying a bone on plain x-ray is almost impossible, and in most cases, plain
radiography is not useful. CT scanning can identify both the site of any impacted bone,
as well as any complications such as perforation and abscess formation[16].
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This man presented with left iliac fossa pain and fever, and was suspected of having
diverticulitis clinically. He had a perforation due to a chicken bone (Fig. 18 on page 26).
Intravascular Foreign Bodies and Misplaced Medical Devices.
1. Needle in IVC
Drug taking is common in Western society, as is not restricted to addicts and criminals.
There is a growing number of "middle class users" who have permanent employment,
and typically restrict their drug use to weekends. With this "respectable" lifestyle, it is
not desirable to have track marks on the wrists or elbows, where they might be seen by
workmates or the boss, so the groin becomes a good alternative, with large superficial
veins, and track marks covered by clothing. This young male did just that, but the needle
broke off in the groin and embolised to the IVC, where the needle became embedded
in the vessel wall (Fig. 19 on page 26). The result was extensive thrombosis of the
lower limb vessels and IVC with extensive collateral formation (Fig. 20 on page 27).
His legs were massively swollen and oedematous, but fortunately he did not develop
arterial compromise.
2. Mercury
Surprisingly, there are multiple case reports of attempted suicide by injection of
mercury[17, 18], and perhaps less surprisingly, almost none were successful. This patient
also tried this method, producing a mercury "angiogram" on chest x-ray (Fig. 21 on page
29). The mercury is still visible almost 20 years later.
3. Intrauterine Devices (IUDs)
The strings on Mirena intra-uterine contraceptive devices should be visible on direct
inspection of the vagina, but can difficult to find. Pelvic ultrasound readily locates the IUD
when still in the uterus. If ultrasound does not locate the device, abdominal x-ray can
assist in determining if the IUD is in the abdomen, or whether it has been expelled (Fig.
22 on page 29). Perhaps a check would have been appropriate in this patient before
inserting another IUD!
When an IUD is present on x-ray but not seen in the endometrial cavity with ultrasound,
cross-sectional imaging is required to localise the device. This female presented with
pelvic discomfort 2 weeks post Mirena insertion. The device has migrated through the
wall of the uterus into the peritoneal cavity (Fig. 23 on page 30).
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4. Twiddler syndrome
A small minority of patients with pacemakers find their presence irresistible and cannot
leave them alone. This fiddling or "twiddling" can dislodge the pacing wires with
subsequent inactivation of the device (Fig. 24 on page 31, Fig. 25 on page 32).
There have been case reports of fatal arrhythmias and short-circuiting because of this
condition[19, 20]. The outcome can be equally as disastrous if the device is for the
purposes of deep brain stimulation.
5. Mal-positioned chest drain
When learning to insert chest drains, the traditional teaching was to insert the drain
through the posterior or posterolateral chest wall, to avoid the mediastinal structures. This
drain was inserted anterolaterally on the left, which in an elderly woman with a cardiac
history, resulted in the drain being placed directly through the cardiac apex and into the
left ventricle. A CT scan was performed to check drain position when only blood was
draining through the tube (Fig. 26 on page 34).
6. Gastric Bands
Ten years ago, few radiologists would have seen a gastric band, yet now they are
commonplace. Our clinical colleagues are often unaware of the propensity of these bands
to move, and often the patient has not even told the doctor they have a band in place.
The band is placed around the proximal stomach and sutured in place to produce a
small proximal pouch that limits the volume of food consumed and makes the patient feel
satisfied after a very small meal, thus allow weight loss to occur. On a frontal x-ray, the
band should appear in profile as linear structure forming an angle of between 4 and 58
degrees (Fig. 27 on page 34). This is known as the Phi angle[21, 22].
Slippage of the band results in a Phi angle of above 58 degrees (Fig. 28 on page 36).
Slippage will vary from asymptomatic in some patients, to pain, nausea, vomiting and
food intolerance in others. Severe slippage can produce gastric infarction and perforation
due to gastric volvulus.
7. Surgical Instruments.
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It is fortunately rare for surgical instruments to be left inside a patient at the end of surgery.
A count of swabs may sometimes be incomplete, as these small pads can soak up body
fluids and "hide" quite neatly within the patient. Metal instruments are usually far more
obvious inside the patient. This patient had a CT scan 2 months after abdominal surgery
which revealed a forgotten pair of scissors (Fig. 29 on page 38, Fig. 30 on page 40).
Subcutaneous Foreign Bodies
1. Splinters
Most small, superficial foreign bodies are visible to the naked eye and can be easily
removed, but deeper items can be very difficult to localise for removal. Ultrasound has
made this process much easier, but there are some traps that can give false negative
results. The ultrasound beam must be angled appropriately to enable the foreign body to
be seen (Fig. 31 on page 40, Fig. 32 on page 41).
In small parts, such as fingers or toes, a "stand-off" gel can also be invaluable in finding
these tiny foreign bodies (Fig. 33 on page 42, Fig. 34 on page 43).
2. Cosmetic fillers
The cosmetic medical industry has exploded world-wide over the past few decades. Nips,
tucks, implants, Botox and fillers are all commonplace, used by celebrities and the general
public alike. Rogue practitioners have brought the industry into disrepute, with reports of
complications including infection, implant movement and even death in the media. This
patient visited an unaccredited clinic and had facial filler injected (Fig. 35 on page 44,
Fig. 36 on page 45). The CT shows linear areas of silicone/paraffin injected directly
into the subcutaneous tissues of the face[23].
Other items in allsorts of places……
1. Taser in eye
A man had just robbed a store in Adelaide's popular Rundle Street. While running from
the police, he turned and looked back just as a TASER was discharged. One of the
TASER electrodes lodged in the right orbit, just penetrating the globe (Fig. 37 on page
46). CT scan shows very clearly the electrode in the orbit, with the tip just perforating
the inferior sclera.
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2. Rectal deodorant can with haemorrhage
Impacted rectal foreign bodies are a common occurrence in any Emergency Department.
The majority are removed without incident and cause little permanent damage, except to
the pride of the patient. There is potential for significant and even life-threatening injury
if the rectum is perforated, which can lead to peritonitis, sepsis and death.
This teenager presented with torrential rectal haemorrhage requiring transfusion. A CT
scan was performed to identify a site of bleeding for potential embolisation. A foreign
body was seen in the rectum (Fig. 38 on page 47), which was later ascertained to be
a deodorant can lid (Fig. 39 on page 48). The sharp edge of the lid had lacerated the
rectal mucosa causing a massive haemorrhage.
3. Drug packing
A young woman suddenly collapsed without warning while on an international flight
coming into Australia. The jet made an emergency landing and the patient was retrieved
to hospital. A CT scan was performed to investigate the collapse, as the patient was
travelling alone and was unable to give any history. The CT scan show multiple small
packages in the stomach (Fig. 40 on page 49), bowel and vagina (Fig. 41 on page
51). The packages contained several hundred grams of heroin, and one must have
leaked. The woman was successfully resuscitated and treated and is still living in
Australia at Her Majesty's pleasure.
4. Myodil
Iophendylate, an oil-based contrast agent used for myelography up until the 1980s, was
marketed as Myodil in Australia, and Pantopaque in North America. It was withdrawn
from sale in the 1980s, and class actions against the manufacturers followed when it was
recognised that iophendylate caused crippling arachnoiditis in the brain and spine[24].
Many patients are not aware that they were injected with Myodil so it rarely appears in a
patient's medical history. For the uninitiated, the appearance can be startling on both CT
and MRI, where it can mimic metallic artefacts and aneurysms, as in this elderly female
(Fig. 42 on page 51). On specific questioning, she recalled having a myelogram in
the late 1970s.
5. Bladder stone??
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Not everything is as it first seems! This elderly woman presented with left flank pain
and fever, and was found to have an infected, obstructed kidney. The bladder stone
seen on the x-ray (Fig. 43 on page 53) was assumed to be part of the cause, but
cystoscopy found an empty bladder. It is only when turning the image sideways that the
true culprit becomes evident (Fig. 44 on page 53)- a toy smurf!! Successfully retrieved
and removed by the gynaecologists.
Images for this section:
Fig. 1: Chest x-ray in a 2-year-old child who choked while eating his dinner. There is no
foreign body visible.
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Fig. 2: Expiratory view in the same child reveals severe air trapping in the left lung,
suggesting a "ball-valve" obstruction to the left main bronchus. A meatball was removed
via bronchoscopy.
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Fig. 3: Photograph of a plastic tag commonly used to secure bread bags.
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Fig. 4: Non-contrast axial CT image of a 47-year-old male with 2 months of abdominal
pain. There is a linear foreign body in the small bowel.
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Fig. 5: 3D reconstruction of the same patient revealing the foreign body to be a bread tag.
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Fig. 6: Non-contrast axial CT image of an 83-year-old female. A linear foreign body was
identified in the small bowel.
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Fig. 7: Reconstructed image in the same patient showing the bread tag in the small bowel.
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Fig. 8: Post-contrast axial CT image of a 56-year-old male with right iliac fossa pain and
peritonism. A linear foreign body can be seen perforating a loop of small bowel(arrow).
Surgery revealed a toothpick lodged within a Meckel's diverticulum.
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Fig. 9: X-ray of a 5-year-old female with increasing abdominal pain. X-ray shows a bubbly
appearance to the distended stomach despite fasting.
Fig. 10: Barium meal in the same patient, showing the large filling defect of the
trichobezoar.
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Fig. 11: Ultrasound scan of a 5-year-old child with suspected appendicitis. The appendix
is not inflamed, but contains multiple small, wriggling pin worms.
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Fig. 12: Post-contrast reconstructed CT image of a 51-year-old male with abdominal pain.
The worm is in the small bowel, and has already ingested some oral contrast. Note the
thin hyperdense line centrally within the parasite, which is contrast in the alimentary tract.
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Fig. 13: Abdominal x-ray in a 2-year-old child showing the swallowed battery projected
over the stomach.
Fig. 14: Ultrasound scan in the same child. The button battery enters the proximal pyloric
canal, but is too large to pass through, and is "rejected" back into the lumen of the
stomach.
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Fig. 15: Lateral neck x-ray in a 54-year-old male complaining of a fishbone stuck in his
throat. The x-ray is normal.
Fig. 16: Post contrast axial CT in the same patient. The fishbone is seen as a tiny "dot"
on the right (arrow).
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Fig. 17: Coronal reconstruction in the same patient accurately shows the position in the
right vallecula and the length of 2 cm.
Fig. 18: Post-contrast sagittal CT image of a 49-year-old man with left iliac fossa pain and
fever. CT shows a small chicken bone impacted in the sigmoid colon with surrounding
inflammation. There was a small amount of free gas present confirming perforation.
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Fig. 19: Post-contrast axial CT image of a 34-year-old male with extensive bilateral
deep vein thrombosis. There is a linear foreign body in the small calibre, thrombosed
IVC(arrow). This is the needle that broke off in the groin. Note the distended hemiazygous
vein and large subcutaneous collateral vessels that have developed as a result of the
deep venous occlusion.
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Fig. 20: 3D reconstruction in the same patient, showing the massive collateralization as
a result of the IVC occlusion.
Fig. 21: Chest x-ray of a 37-year-old male who attempted suicide by injecting mercury into
the median cubital vein. This stunning "pulmonary angiogram" is still present, although
less impressive 2 decades after the event.
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Fig. 22: Pelvic x-ray in a 50-year-old female. There are 3 Mirena IUDs in the pelvis.
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Fig. 23: Non-contrast coronal CT image of a 30-year-old female with pain after Mirena
insertion. The device is clearly seen within the peritoneal cavity, have migrated through
the myometrium.
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Fig. 24: Chest x-ray of an elderly man after insertion of the multi-lead defibrillation device.
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Fig. 25: Chest x-ray of the same patient 2 years later, showing the wires to be looped
and twisted near the device(arrow). The patient admitted to "twiddling" with the device
when questioned.
Fig. 26: Non-contrast coronal CT image of an 88-year-old lady. A tragic tale of mishaps,
with the drain initially inserted into the right side of the chest (which does not have
an effusion). This was removed and a tube was inserted on the left. A CT scan was
performed when a large amount of bright blood drained from the tube. The drain had
been fatally positioned through the apex of the enlarged heart, into the left ventricle.
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Fig. 27: Abdominal x-ray in a patient with a correctly positioned gastric band, showing
a normal Phi angle, and linear profile.
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Fig. 28: Abdominal x-ray in a different patient, showing a circular profile to the band with
an increased Phi angle confirming slippage of the device.
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Fig. 29: CT scout view in a 72-year-old male, performed 2 months after a bowel resection.
The scissors can be seen in profile in the left upper quadrant.
Fig. 30: Axial CT image in the same patient showing the scissors sitting above the
stomach and left lobe of liver.
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Fig. 31: Ultrasound of the foot in a 16 year who stepped on broken glass. A subtle linear
object is visible, consistent with a fragment of glass(arrow).
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Fig. 32: Ultrasound of the foot in the same patient, using a different angle on insonation.
Two glass splinters are now obvious(arrows).
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Fig. 33: Ultrasound of the shin in a 9-year-old boy with a wooden splinter in the shin. A
foreign body is not seen.
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Fig. 34: Ultrasound of the shin in the same child using a "stand-off" gel. The splinter is
now visible(arrow).
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Fig. 35: Non-contrast axial CT image of a middle-aged female patient. The linear
densities in the subcutaneous tissues were an incidental finding on this sinus CT scan.
This patient had subcutaneous injections of facial "fillers" while on holiday in Thailand.
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Fig. 36: 3D reconstruction in the same patient, showing the extent of the facial "filler".
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Fig. 37: Non-contrast sagittal CT image of a 35-year-old male who turned around as
police discharged the TASER. The electrode is clearly seen within the orbit, penetrating
the globe. Some might call this justice……
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Fig. 38: Post-contrast axial CT image of a 13-year-old male presenting with rectal
haemorrhage. The CT angiogram shows a blood-filled rectum with a thin, circular foreign
body.
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Fig. 39: Sagittal reconstruction in the same patient shows a dome shaped foreign body
which proved to be a deodorant can lid. The sharp lower edge had lacerated the rectal
mucosa causing the haemorrhage.
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Fig. 40: Non-contrast coronal CT image of a young female. Dense packages are seen
in the stomach, vagina and rectum. The packages were found to contain heroin which
must have leaked and been absorbed, causing her collapse.
Fig. 41: Sagittal CT in the same patient showing packages in the colon, rectum and
vagina.
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Fig. 42: Non-contrast axial CT image of an elderly female. Multiple dense artefacts are
present in the subarachnoid space, which is residual Myodil from a myelogram many
year ago. This patient was fortunately asymptomatic.
Fig. 43: Abdominal x-ray in a 67-year-old female with left hydronephrosis. A "bladder
calculus" is seen in the pelvis.
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Fig. 44: Magnified image of the "stone" rotated through 90 degrees. The true nature of
the "stone" is revealed - a "drummer smurf"!!
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Conclusion
The recognition and identification of foreign bodies by the radiologist is very important,
and can be life-saving if clinically unsuspected.
Personal information
Dr Sarah Constantine MBBS, FRANZCR
Consultant Radiologist
The Queen Elizabeth Hospital
The Women's and Children's Hospital
South Australia.
Dr James Buckley MB BCh, FRCR, FRANZCR
Consultant Radiologist
Royal Adelaide Hospital
South Australia.
References
1. Sahin A, Meteroglu F, Eren S, Celik Y. Inhalation of foreign bodies in
children: experience of 22 years. J Trauma Acute Care Surg.
2013;74(2):658-63.
2. Norrie MW, Chapman G, Connor SJ. A case of upper gastrointestinal
bleeding secondary to a bread bag clip. Aust N Z J Med. 1997;27(1):75.
3. Newell KJ, Taylor B, Walton JC, Tweedie EJ. Plastic bread-bag clips in
Page 55 of 58
the gastrointestinal tract: report of 5 cases and review of the literature.
CMAJ. 2000;162(4):527-9.
4. Greenup AJ, Wright D, Koorey D. Gastrointestinal: Bread bag clip
ingestion: Cause for concern. Journal of Gastroenterology & Hepatology.
2016;31(2):283-.
5. Tang AP, Kong AB, Walsh D, Verma R. Small bowel perforation due to
a plastic bread bag clip: the case for clip redesign. ANZ J Surg.
2005;75(5):360-2.
6. Beer T. Fatalities from bread tag ingestion. Medical Journal of Australia.
2002;176(10):506.
7. Mouawad NJ, Hammond S, Kaoutzanis C. Perforation of Meckel's
diverticulum by an intact fish bone. BMJ Case Rep. 2013;2013.
8. Cotirlet A, Anghel R, Tincu E, Rau S, Motoc I, Popa E. Perforation of
Meckel's diverticulum by foreign body, a rare complication. Chirurgia
(Bucur). 2013;108(3):411-3.
9. Prociv P. Gastrointestinal worm infections. The prevalence and
treatment in Australia. Aust Fam Physician. 2001;30(8):755-61.
10. Vijayaraghavan SB. Sonographic whipworm dance in trichuriasis. J
Ultrasound Med. 2009;28(4):555-6.
11. Ortega CD, Ogawa NY, Rocha MS, et al. Helminthic diseases in the
abdomen: an epidemiologic and radiologic overview. Radiographics.
Page 56 of 58
2010;30(1):253-67.
12. Hamilton JM, Schraff SA, Notrica DM. Severe injuries from coin cell
battery ingestions: 2 case reports. J Pediatr Surg. 2009;44(3):644-7.
13. Chessman R, Verkerk M, Hewitt R, Eze N. Delayed presentation of
button battery ingestion: a devastating complication. BMJ Case Rep.
2017;2017.
14. Tanigawa T, Shibata R, Katahira N, Ueda H. Battery ingestion: the
importance of careful radiographic assessment. Intern Med.
2012;51(18):2663-4.
15. Liew CJ, Poh AC, Tan TY. Finding nemo: imaging findings, pitfalls, and
complications of ingested fish bones in the alimentary canal. Emerg
Radiol. 2013;20(4):311-22.
16. Dominguez-Jimenez JL, Jaen-Reyes MT. Sigmoid colon diverticulum
perforated by a chicken bone. Rev Gastroenterol Mex.
2015;80(1):107-8.
17. Tan A, Neo WT, Phua J. Images in radiology. An element of surprise.
Mercury poisoning. Am J Med. 2010;123(10):910-2.
18. Marie I, Bernet J, Beduneau G, Auquit-Auckbur I, Houy-Durand E,
Levesque H. Intravenous self administration of mercury. QJM.
2008;101(8):667-8.
19. Dharawat R, Saadat M. Twiddler's syndrome. Acta Med Acad.
Page 57 of 58
2016;45(2):169-70.
20. Tonino WA, Winter JB. Images in clinical medicine. The twiddler
syndrome. N Engl J Med. 2006;354(9):956.
21. Levine MS, Carucci LR. Imaging of bariatric surgery: normal anatomy
and postoperative complications. Radiology. 2014;270(2):327-41.
22. Pieroni S, Sommer EA, Hito R, Burch M, Tkacz JN. The "O" sign, a
simple and helpful tool in the diagnosis of laparoscopic adjustable
gastric band slippage. AJR Am J Roentgenol. 2010;195(1):137-41.
23. Gu DH, Yoon DY, Chang SK, et al. CT features of foreign body
granulomas after cosmetic paraffin injection into the cervicofacial
area. Diagn Interv Radiol. 2010;16(2):125-8.
24. Wang SC, Lu PS, Wu PW, Yeh CH, Wang CJ, Chang CC. Intracranial
migration of iophendylate four decades after conventional
myelography. Br J Neurosurg. 2016:1-2.
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