This is not something you want to see on an MRI. The patient was a 3 y.o. boy with a suspected upper respiratory tract infection. But why has most of his face disappeared from the scan?
Luckily the radiologist realised immediately what was going on and terminated the procedure. The shadow on the image suggested a ferromagnetic foreign body somewhere in nasal or oral cavities - which in the powerful magnetic field of an MRI scanner might have done serious damage.
The child had been given a general anaesthetic for the MRI - which was fortunate, because he had resisted all attempts to examine him at close quarters while conscious. Now the ENT physicians found and easily removed a small button cell from his nasal cavity.
Interestingly, a second MRI showed that there was still some ionic material left behind in the mucosa - the shaded areas corresponding to the right nasal cavity. The symptoms quickly resolved with antibiotics and the child made a good recovery.
Button cells and small children don't mix - keep well apart! The full case report can be read here: ncbi.nlm.nih.gov/pmc/articles/P…

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More from @thomasngmorris

10 Jan
An X-ray taken in early 1936 - 85 years ago! The patient was a 'pale and debilitated' 5 y.o. girl who had been admitted to hospital with spots of blood in her urine and general malaise. So what's going on here? Image
The parents mentioned that the girl had swallowed a metal hair-slide a year earlier, 'but little importance was attached to this statement'. Instead the doctors administered mandelic acid (a pre-antibiotic era antibacterial drug), as if it were just a urinary tract infection. Image
But an X-ray showed that it really wasn't just another urinary tract infection. That is a Kirbigrip, ingested a year earlier! But where had it lodged? Image
Read 6 tweets
5 Jan
A few years ago a 59-year-old man walked into a hospital in eastern France and asked to see a doctor. He had no symptoms, but said he had been advised to get an X-ray. This is it:
A lateral view gives a slightly clearer view of a foreign body in the lower lobe of the left lung. What could it be?
A dental drill bit! The patient explained that a little earlier his dentist had accidentally dropped it in his mouth and he had inhaled it. It had caused no immediate trouble but the dentist, aghast, told him he needed to get it extracted ASAP. 😱
Read 6 tweets
2 Jan
Think your day's going badly? It could be worse.

Pelvic X-ray of a 41-year-old male patient, previously fit and well. But what on EARTH is going on here?
Ah. That's what's wrong. An egg-shaped piece of marble is what's wrong. And the marijuana-based removal regime failed to work, you say?
This was, in all seriousness, a major surgical challenge. The object was too large and smooth to be removed from the rectum via the anus. It would not fit through the pelvic opening, and the surgeons felt it was also impossible to remove via the peritoneal cavity. What to do?
Read 6 tweets
2 Jan
Here's a chest X-ray that made the radiologist gasp and reach for the phone. What could this thin grey line possibly be? The patient was a 30 yo male, no significant medical history, who had started to experience stabbing pains in his chest a few days earlier.
A CT gives a clearer view of something definitely abnormal. The patient, who worked in a sofa factory, "firmly excluded recent trauma or accidental
injuries", though doctors noticed a small puncture injury on the left chest wall.
A planned echocardiogram was abandoned when he started to sweat violently, his blood pressure dropped and his jugulars became distended. Cardiac tamponade, you cry! And so he was whisked into surgery, where a large excoriation was found in the wall of the left ventricle.
Read 7 tweets
1 Jan
This is a really interesting epidemiological tale. In 1965, physicians in Quebec started to notice a sharp increase in the incidence of heart failure. All these patients drank beer, in most cases rather heavily.
The cause was mysterious. Researchers thought the etiology might be viral, and despite some anomalous immunological findings no culprit virus was identified.
There was already a known association between alcoholism and cardiomyopathy - but this seemed to be a distinct syndrome. Mystifyingly, some chronic drinkers were entirely unaffected.
Read 7 tweets
31 Dec 20
A 41 yo woman with mild asthma was getting ready for a New Year's Eve party. Shortly after taking a puff from her salbutamol inhaler she experienced a painful cough and haemoptysis (coughing up blood, ~100 ml). In hospital a chest X-ray revealed this; but what is it? Image
Answer: an earring! The patient had left her asthma inhaler uncapped, and a loose earring in her handbag had fallen into the reservoir. In this CT you can see the earring lodged in the right bronchus intermedius. But how to get it out? Image
The respiratory team performed bronchoscopy under sedation.

"There were increased mucoid secretions throughout the right bronchial tree, but a heart shaped diamante earring was identified in the right lower lobe bronchus, where it was causing subtotal occlusion." Image
Read 5 tweets

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