Foreign bodies radiology

It is important that the radiologist is familiar with the wide range of foreign bodies that can be found, as they can have any legal and ethical implications: gossypiboma, intentionally hidden drugs, and suicide attempts

Foreign bodies are rare, but not cease to be important and interesting. You can sometimes go unnoticed or simulate the appearance of a medical device.

Learning objectives

- Describes the different foreign bodies and differentiate potential simulators

- Illustrate the radiologic findings of foreign bodies

- Recognize the different mechanisms by which a foreign body can be found in the human body

MECHANISMS

 

Ingestion

 

Frequently in: children  , mentally disabled adults in unusual sexual behaviour and "normal" people with predisposing factors or social problems .




Evolution normally run through the gastrointestinal tract without obstruction  problem but can occur in areas of reduced size / angulations
Complications: inflammation, ulceration, perforation, toxicity and corrosion in some instances (battery).



Special situations: “mules” or “body packers”, ingestion of toxic substances (barium, lead, arsenic, thorium, bismuth, iron, iodine compounds)


Insertions

 

Frequently in: kids and adults curiosity or mentally disabled
Location: rectum  vagina, urethra, bladder, nose and ear.



Evolution: In general no damage, sometimes mucosal lesions can be embedded minerals and exceptionally be drilled.

Complications: bleeding from mucosal injury, edema that prevents removal of the object, organ perforation, bleeding, abscesses and sepsis.


Injuries

 

Frequently in: mental, therapeutic unconventional disabled, sexual deviance, drug and alcohol abuse, military personnel, offenders, victims of abuse

Types: firearmsو  knivesو  accidents / labour, iatrogenic .






Diagnosis is usually difficult for non-radiopaque requiring ultrasound or MDCT for identification

Complications: pain, discomfort, swelling, cellulitis, abscesses, migration vascular or nerve damage


PEDIATRIC POPULATION

Airways

Accidents are the leading cause of death in childhood, the most common: trauma, foreign bodies, poisoning and burns

Aspiration of foreign body airway is common and important to be serious and the possible consequences .



Very common in <5 years, predominantly males (2: 1)

Only be diagnosed if suspected

The normal radiograph does not exclude its existence to exist so clinical suspicion must be made bronchoscopy

Digestive tract

Foreign body aspiration to frequent paediatric digestive tract immaturity of the mechanisms of swallowing and high curiosity bucolingual

Clinical: nausea, salivation, vomiting, hematemesis, abdominal pain, sore throat and tracheal oppression

More common in <3 years

The normal radiograph does not exclude its existence to exist so clinical suspicion must be made endoscopy

Rate background: caustic ingestion, oesophageal atresia, oesophageal surgery, psychiatric illness...

 ASPIRATION IN ADULTS

Aspiration of solid foreign bodies to the airways

Clinical: variable, from silent even fatal haemoptysis

Clinical and radiological manifestations depends on the size of the aspirate, level and evolution (acute / chronic)

Aspirated material: food and bits of teeth 



Conventional radiology: atelectasis, radiopaque foreign body (5-15% of cases)

CT may provide diagnostic information by showing subtle low-attenuation intrabronchial material, which is often the only finding that can lead to the diagnosis and identification of the level of obstruction. CT is also more specific than radiography for characterizing the attenuation of a suspected foreign body

Late complications: bronchial stenosis, massive haemoptysis, bronchiectasis, inflammatory granulation tissue or mass at the site of lodgement, or recurrent pneumonia.

Aspiration of liquid materials

Clinical and radiological depends on the volume, pH, underlying abnormalities (oesophagus or tracheobronchial) and evolution (acute / chronic / recurrent) events
Location: posterior segments of the upper lobes and superior segments of the lower lobes

Gastric acid (Mendelson syndrome): respiratory distress

Water Dives: opacities "ground-glass"

Chronic exogenous lipoid pneumonia: crazy-paving

Acute exogenous lipoid pneumonia (or “fire-eater’s pneumonia”)

Infectious material from oropharynx

Foreign bodies in oesophagus

Usually in children and older people, but sometimes accidental generally voluntary (prisoners, psychiatric)

Location: below the upper oesophageal sphincter 



Clinic: dysphagia, salivary retention pyriform sinuses, nausea, local pain and even coughing, cyanosis and suffocation.

SOFT TISSUES

High percentage (38% cases) of foreign bodies in soft tissue overlooked in the initial studies

Types: wood splinters, glass, metal and plastic 





US data: degree of echogenicity, posterior shadowing and reverberation, surrounding hypoechoic rim, and possible complications (muscles, tendons, ligaments, and neurovascular structures) 



Conventional Radiology useful if they are radiopaque

MR: high cost and less availabilities

ABDOMEN AND PELVIS

Foreign objects are not infrequently encountered at computed tomography (CT) of the abdomen and pelvis. Most of these objects are related to prior surgery or some other interventional medical procedure.

Intraluminal

A variety of objects may be found within the lumen of the gastrointestinal tract. We have categorized these objects according to whether they are the result of

 

  • Pathological conditions: bezoar and stones 



  • Following procedures: biliary stents, feeding tubes 



  • Diagnostic intake devices: pH meter capsule, endoscopic capsule

  • Accidental  or voluntary intake 





Extraluminal

Like intraluminal foreign bodies, they may be related to prior surgery or some other medical procedure. Some of these objects are meant to remain within the body for therapeutic purposes, whereas others may have been left behind unintentionally, possibly leading to clinical consequences

 

  • Previous surgery: meshes, surgical clips  , migration intrauterine device



  • Intentionally placed surgical material: abdominal sponges for hepatic packing, bio-absorbable sponges, urethral bulking agents

  • Unintentionally retained surgical materials (gossypibomas) 



  • Traumatic