Omental actinomycosis mimicking a foreign body infection

Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces species. Abdominal actinomycosis is a rare condition and difficult to diagnose before surgery. Here, we report a case of omental actinomycosis mimicking a foreign body infection on computed tomography (CT). A 47-year-old man presenting with abdominal pain had a heterogeneous area comprising a 2-cm long linear radiopaque material with surrounding enhancing soft tissue density lesions and fat infiltrates, measuring 9 × 8 cm in the omentum of the right upper quadrant on CT. We assumed that the linear radiopaque material was a foreign body, such as a fish bone. Laparoscopy-assisted right hemicolectomy and partial omentectomy were performed under radiological suspicion of foreign body infection. Histological examination revealed the omental lesion to be actinomycosis. The patient was treated with antibiotics for 10 weeks, and he recovered well without any complication. Omental actinomycosis mimicking a foreign body infection is rare. The experience and knowledge regarding the variable CT findings of abdominal actinomycosis are useful because it should be differentiated from malignancy and other inflammatory conditions.     

Acute epiglottitis mimicking esophageal foreign body

When epiglottitis presents in association with a normal or near-normal body temperature, the symptoms may simulate those of an esophageal foreign body so closely that an esophagram is requested. A preliminary evaluation of the epiglottis on the foreign body series or at fluoroscopy can prevent the potential morbidity associated with performing an esophagram on a patient who actually has epiglottitis.     

Ingested foreign body mimicking an appendicolith in a child

We describe an unusual case of a child who had ingested sand and stones and presented with signs and symptoms suggestive of appendicitis. Plain radiographs revealed calcific opacities in the right iliac fossa simulating appendicoliths. At surgery and histopathology a small sealed off perforation of the terminal ileum with hard concretions in the wall was observed.     

Silver nitrate mimicking a foreign body in the pharyngeal mucosal space

Silver nitrate is sometimes used as a means of chemical cauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports available on the imaging appearance of silver nitrate and its potential to mimic a foreign body. We report a case of a patient presenting with dysphagia, odynophagia, and fever following dental work who had a peritonsillar incision and drainage for treatment of a deep neck space infection. During the procedure, silver nitrate was applied to halt the bleeding. Patient was subsequently transferred to another institution. Since the patient was not showing significant clinical improvement on antibiotic therapy, a computed tomography (CT) scan was performed demonstrating a hyperdense structure lodged in the pharyngeal mucosal space in the oropharynx and soft palate that was mistaken for a foreign body such as bone. Silver nitrate can have density similar to bone but does not have the normal architecture of bone with cortex and marrow on CT. Familiarity with the appearance of silver nitrate on CT, lack of bone architecture, and proper documentation and communication of the use of silver nitrate to the consultant radiologist and medical personnel could help avoid misdiagnosis and potentially unnecessary surgical exploration.     

A 40-year-old gossypiboma (foreign body granuloma) mimicking a malignant femoral surface tumor

The patient was a 61-year-old man who developed gossypiboma of the left thigh and femur resulting in the imaging appearances of a malignant surface tumor. He had a past history of surgery on the left femur for open fracture 40 years previously. Radiographs and CT showed a soft tissue mass with osteolysis and periosteal thickening of the left femur. On MRI, the mass showed heterogeneous signal intensity with contrast enhancement at the periphery, suggesting a malignancy. ^99mTc-HMDP bone scintigraphy showed a faint ring-like uptake, but thallium -201 scintigraphy did not show any uptake in the tumor. An extensive intralesional excision was performed. Postoperative histopathological examination showed a fibrous foreign body with reactive changes. There were neither viable cells nor atypical giant cells around the foreign body. No malignant change was evident. Based on surgical and histopathological examinations, the tumor was finally diagnosed as gossypiboma related to a retained surgical sponge.The patient was treated by Dr. Kenshi Sakayama at Ehime University Hospital, Ehime, Japan     

Intraorbital wooden foreign body (IOFB): mimicking air on CT

We report the case of a 41-year-old man who presented to the ER following a fall in his back garden during which he sustained a left orbital injury. Computed tomography (CT) demonstrated an intraorbital linear lucency surrounded by haziness in the intraconal fat. An intraocular wooden twig was confirmed during subsequent surgery. The possibility of a wooden intraorbital foreign body should be strongly suspected following orbital trauma when there is intraorbital density below that of the surrounding intraorbital fat on CT, as this may mimic organic foreign bodies.     

螺旋CT探测心血管内游走性金属异物2例

例1 患者男，53岁。在检查车床时被飞溅的异物射伤，3d后以“外伤致心内异物”入院。查体腹部膨隆，全腹软，无压痛及反跳痛，剑突左下可见一针眼大小伤口，周围见3cm×4cm血肿。 CT检查：双侧胸廓对称，纵隔居中，肺内未见结节及斑片影，纵隔窗于主动脉根部见-2cm×1cm针样金属密度影，再次行胸部透视时异物消失，考虑异物游移。行腹部透视见异物移至腹主动脉平第3、4腰椎体之间。     

CT of a peripatetic intracranial foreign body

We report the CT appearances of a low-velocity missile that lodged within the brain and which subsequently migrated spontaneously back along the entry path. We review the literature of similar instances of migration and draw conclusions about the presurgical radiological management.     

Unusual migration of a foreign body from the gut to a vertebral body

We report a unique case in which a needle was accidentally swallowed and migrated into the vertebral body. Plain films and CT of the spine revealed fragmented, linear, metallic-density material in the L3 vertebral body. The possible mechanisms of the migration are discussed. Received: 6 October 1997 Accepted: 26 February 1998     

Silver nitrate masquerading as a radiopaque foreign body

Silver nitrate is commonly used as a method of chemical cauterization to areas of hypergranulation. We report two cases wherein silver nitrate in the hand was misinterpreted radiologically as foreign bodies.     

Use of a metal detector to identify ingested metallic foreign bodies

A metal detector reveals the presence of metallic objects by measuring the change in the inductance of a coil placed near a metallic mass. The device used in this study is similar in principle to those used for passenger surveillance in airports except for its smaller size and simpler design. In this study, we compared the accuracy of a metal detector with that of plain radiographs for the localization of ingested metallic objects. Twenty-eight consecutive patients with the presumptive diagnosis of metallic foreign-body ingestion were examined with a metal detector. The results were compared with those of plain radiographs which were considered the gold standard. Fifteen positive cases and 13 negative cases were correctly diagnosed by metal detector examination. No false-positive or false-negative results occurred. Our experience suggests that metal detection is a simple and accurate technique for the localization of ingested metallic objects and provides information equivalent to that from plain radiographs for the treatment of patients with suspected foreign-body ingestion.     

Imaging of a foreign body in the submandibular space

Foreign bodies in the oral cavity are infrequent in children. In spite of a negative clinical exploration, US and CT showed the suction cup of a rubber-tipped dart in the left submandibular space of a 3 year-old child. Surgery could be guided by these investigations.     

Post-operative intracranial foreign body granuloma: a case report

Summary The authors report and discuss some clinical, radiological, histological and ultrastructural aspects of an intracranial foreign body granuloma. This granuloma, which simulated a cavernoma, was due to a surgical swab forgotten during a previous neurosurgical evacuation of an intracerebral hematoma.     

Obstructive rectal intramural hematoma caused by a foreign body

Intramural hematoma of the alimentary tract is a rare condition, which usually results from blunt injury. It can spontaneously occur in patients with coagulopathy or on anticoagulants. Although it may be seen anywhere in the alimentary tract, duodenum is the most common site of the intestinal intramural hematomas. Intramural hematoma caused by a foreign body is rarely seen. Patients with intramural hematoma are usually encountered with obstructive symptoms after an isolated injury. Intramural hematomas are often self-limited at the site of occurrence and can be managed conservatively. They rarely cause progressive obstruction and need surgical drainage. In this article, we report a 51-year-old male patient with foreign body used for masturbation causing rectal intramural hematoma and perforation at the rectosigmoid junction. Because of the intestinal perforation, the patient was managed surgically. In the diagnosis of intramural hematoma of the alimentary tract, beside the clinical history and physical examination, the findings at imaging modalities such as conventional radiography, ultrasonography, and computed tomography are often useful. Patients with rectal intramural hematoma usually do not give diagnostic clues to the physicians in the clinical history. Therefore, radiologists must be familiar with the imaging findings. In this article, we aimed to present a patient with rectal intramural hematoma caused by foreign body and obliterating the rectal lumen.     

Perforation by a foreign body through a pre-existing radial keratotomy wound

A case is presented demonstrating selective perforation of a foreign body through a pre-existing partial thickness radial keratotomy wound. This is the initial documentation of a distinct type of injury to which an eye is susceptible following corneal refractive procedures. Despite the excellent outcome, the occurrence of this injury in a soldier during a field training exercise provides additional justification for current Army policy of barring the induction of enlistees who have undergone corneal surgery to correct refractive errors.     

Perforation by a foreign body through a pre-existing radial keratotomy wound

A case is presented demonstrating selective perforation of a foreign body through a pre-existing partial thickness radial keratotomy wound. This is the initial documentation of a distinct type of injury to which an eye is susceptible following corneal refractive procedures. Despite the excellent outcome, the occurrence of this injury in a soldier during a field training exercise provides additional justification for current Army policy of barring the induction of enlistees who have undergone corneal surgery to correct refractive errors.