Neuroradiology (1997) 39: 213–215

 Springer-Verlag 1997 H EA D A N D N ECK N EU RO R AD I OL O G Y

A. Uchino Intraorbital wooden and

A. Kato
Y. Takase bamboo foreign bodies: CT
S. Kudo

Received: 6 March 1996

Abstract We describe the CT find-
Accepted: 15 May 1996 ings of intraorbital wooden and
bamboo foreign bodies in the acute,
subacute, and chronic stages. We
examined four patients using CT a
total of seven times. The CT find-
ings were reviewed. There were
three dry wooden foreign bodies.
CT within a day of the accident
demonstrated wooden foreign bod-
ies as low density relative to sur-
rounding orbital fat, while CT 8–
)
A. Uchino ( ) ⋅ A. Kato ⋅ Y. Takase ⋅
S. Kudo
29 days after the accident showed
them as denser than the extraocular
Department of Radiology, muscles. In the acute stage, dry
Saga Medical School, Nabeshima-5-1-1, wooden foreign bodies mimic air
Saga 849, Japan bubbles. Wooden foreign bodies in
the subacute and chronic stages
should be included in the differen-
tial diagnosis of intraorbital lesions
of soft tissue density or above on CT
of traumatised orbits. There was one
dry bamboo foreign body. Within a
day of the accident it was recognised
as linear lesion isodense with fat.
Therefore, such foreign bodies may
be missed on CT when located in the
orbital fat.
Key words Orbital foreign bodies ⋅
Wooden foreign bodies ⋅ Bamboo
foreign bodies ⋅ Computed
tomography

intraorbital wooden foreign bodies examined serially

Introduction
Wooden foreign bodies in the orbits are reportedly
seen as low density relative to the surrounding fat,
mimicking air bubbles on CT [1–6]. In the chronic
stage, wooden foreign bodies are isodense with or den-
ser than muscle [7–10]. However, we found no report of
using CT, or of intraorbital bamboo foreign body. We
report the CT findings of intraorbital wooden foreign
bodies in the acute, subacute, and chronic stages and
those of an intraorbital bamboo foreign body in the
acute stage.

Table 1 Clinical data and CT Case Age Sex Foreign body Interval from CT attenuation Interval from
findings in patients with (years) accident to CT of foreign body CT to surgery
wooden or bamboo foreign (days) (days)
bodies
1 37 M Dry wood <1 Less than fat <1
2 19 M Dry bamboo <1 Isodense with fat <1
3 73 M Dry wood <1 Less than fat 46
9 More than muscle
17 More than muscle
29 More than muscle
4 69 M Dry wood 8 More than muscle <1
214
a b
Fig. 1 a–c Case 3. a CT several hours after accident. Foreign body
was dry wood. There is an apparent “air bubble” adjacent to the
left inferior rectus muscle (arrow). b Same section window level
− 200 HU and width 2000 HU. The lesion appears more like a for-
eign body than an air bubble. c CT 9 days after a. The lesion is
slightly denser than the extraocular muscles. The inferior rectus
muscle appears swollen, indicative of inflammation
Fig. 2 Case 2. CT several hours after accident. Foreign body was
dry bamboo. There is a line anteriorly of fatty density (arrows).
Since the left medial rectus muscle was penetrated by this linear
structure, a foreign body was identified
Materials and methods
We studied four patients with intraorbital wooden or bamboo for-
eign bodies using CT (Table 1). All were men, aged 37, 19, 73 and
69 years. Three had fragments of dry wood and one of dry bamboo.
In three patients, CT was performed within a day of the accident.
The remaining patient was transferred to our hospital 8 days after
the accident. In three of the four patients, emergency surgery for
the foreign body was performed immediately after the CT. How-
ever, one patient also had an infarct in the territory of his left
middle cerebral artery; since his conscious level was low, surgery
for the foreign body was postponed. He was treated conservatively
with antibiotics, and CT was performed on the 9th, 17th and 29th
days after the accident. Then, on the 46th day, the foreign body was
successfully removed. A total of seven CTexaminations of the four
patients were analysed.
Results
We examined two patients with wooden foreign bodies
within 1 day; foreign bodies were less dense than fat,
mimicking air bubbles (Fig. 1 a). However, CT images
with lower window levels and with wider window widths
demonstrated that the lesions were not air bubbles
c
(Fig. 1 b). The CT studies 8–29 days after the accident
showed the wooden foreign bodies to be denser than the
extraocular muscles (Fig. 1 c).
CT within 1 day of the accident showed a bamboo
foreign body as a linear lesion isodense with orbital fat.
Since the medial rectus muscle was penetrated, the for-
eign body could be identified (Fig. 2, Table 1).
Discussion
There have been several reports of CT of intraorbital
wooden foreign bodies [1–10]. Because of its lower
electron density, wood shows extremely low X-ray at-
tenuation. In vitro, most types of wood are less dense
than fat [11–13], and wooden orbital foreign bodies in
the acute stage are less dense than orbital fat [1–6]. In
some cases, they were initially misinterpreted as air
bubbles on CT. On MRI wooden foreign bodies give
lower signal than fat on both T1- and T2-weighted im-
ages, and MRI is therefore regarded as superior to CT
in this context [2, 5, 6]. However, CT images with
lower and wider windows than routine images can dis-
tinguish a wooden foreign body from an air bubble, as
shown here. We therefore stress that when an “air
bubble” is detected in the orbit of a patient with facial
trauma, the possibility of a wooden foreign body be
considered.
In the chronic stage intraorbital wooden foreign
bodies are reportedly isodense with or denser than soft
tissue [7–10]. The wooden foreign bodies we examined
not only in the chronic stage but also in the subacute
stage (8 and 9 days after the accidents), were all denser
than the extraocular muscles. Because of the inflamma-
tory process, “dry” wood may become “wet” wood
within a few days, resulting in dramatic increases in at-
tenuation on CT. To our knowledge, this is the first re-
port of a case of serial CT of a wooden foreign body
from the acute to the chronic stage. Wooden foreign
bodies should be included in the differential diagnosis of
lesions whose density is similar to or greater than soft
tissue on CT of subacute and chronic trauma to the or-
bits.
To our knowledge, there has been no previous report
of a case of intraorbital bamboo foreign body. Bamboo
appears to be more compact than wood, because our

patient had a lesion isodense with fat. Where the bam-
boo penetrated an extraocular muscle, we recognised it.
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