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RADIOLOGICAL DIAGNOSIS OF FOREIGN BODY

Lamyaa Anwar ALGhafli

Objectives

• Introductions• Foreign bodies in the throat or GIT• Foreign bodies in the airway• Foreign bodies in the soft tissue• Others• Summary• References

Introductions

• Commonly swallowed objects

• Children, aged 1-3 years, are at risk for foreign body.

• It could be in adults also.

Introductions• Foreign bodies can voluntarily or involuntarily be inserted into natural and

unnatural cavities.

• Children account 80% of foreign body ingestions.

• Problems occur when batteries are swallowed. Mercury of the batteries may seep out.

• Magnetic toys can obstruct the bowel when they stick together.

Foreign body

In the throat or GIT

In the airway

In the soft tissue

others

Foreign bodies in the throat or GIT• Throat, esophagus: asymptomatic or drooling, dysphagia, pain if it’s sharp.

• Stomach, small or large intestine: obstruct cause bloat, cramp, vomiting or fever. If sharp: sever pain, fainting, fever and shock.

• Chronic foreign bodies can cause infections in surrounding soft tissues.

• Objects larger than 2 cm are less likely to pass the pylorus, and objects longer than 6 cm may entrapped at either the pylorus or the duodenal sweep.

Foreign bodies in the airway• Usually expelled through coughing.

• If it’s trapped in the lung, it requires bronchoscopy.

• Most (70-90%) foreign bodies are organic, most commonly seeds and nuts.

• Aspirated foreign bodies have a predominance for the right tracheobronchial tree.

• Complete obstruction leads to peripheral collapse but partial obstruction leads to obstructive emphysema.

Foreign bodies in the soft tissues

• It is an object that is stuck in the soft tissue under the skin. Some examples are wood splinters, slivers of metal or glass, and gravel.

• It can cause infections or damage to the surrounding tissues.

Others

Vaginal way “ Intra-uterine contraceptive devices“

Retained surgical instrument

Urethra way “ urinary catheter “

Radiological diagnosis• Ask about: the presence of a medical device or implant, metallic foreign bodies and the possibility of a

pregnancy.

• Plain radiographs: initial screening modality. Metal and glass foreign bodies are detectable but many foreign bodies, including wood, are not.

• Ultrasonography should be the next modality when a suspected superficial foreign body is not delineated on radiographs

• CT for deep foreign bodies or when foreign bodies are not seen on radiographs or ultrasonography but are suspected.

• The patient should undergo endoscopy for definitive diagnosis &treatment.

X-ray of foreign bodies in the airway

CT of foreign bodies in the airway

X-ray of foreign bodies in GIT

CT of foreign bodies in GIT

X-ray of foreign body in the soft tissues

CT of foreign body in the soft tissues

Ultrasound of foreign body in the soft tissues

X-ray of other types

CT of other types

Summary• Foreign body cases commonly in children.

• It could be in any place in the body.

• X-ray as initial screening modality.

• Use ultrasound or CT as screening modality.

• The patient should undergo endoscopy for definitive diagnosis &treatment.

Resources• Text book of radiology and imaging, Daivid Sutton, Seventh edition

• http://www.radiologyinfo.org/en/info.cfm?pg=foreignbodretrieval

• http://radiopaedia.org/articles/airway-foreign-bodies-in-children

• http://www.ncbi.nlm.nih.gov/pubmed/1732094

• http://emedicine.medscape.com/article/405994-overview#a21

• http://pubs.rsna.org/doi/full/10.1148/rg.233025137