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Foreign Bodies¹

¹ From the Department of Radiology, University of Arizona Health Sciences Center, 1501 N Campbell Ave, Tucson, AZ 85724. Received August 2, 2002; revision requested August 28 and received October 15; accepted October 16. Address correspondence to T.B.H. (e-mail: tbh@3towers.com).

View larger version (129K): [in a new window]   Figure 1.  Radiograph of a 28-year-old woman who periodically swallowed pins and razor blades shows an open safety pin in her descending colon. The pin passed without difficulty.

View larger version (119K): [in a new window]   Figure 2.  Radiograph of an 18-month-old child shows a large nail that the child had swallowed. It passed without difficulty.

View larger version (139K): [in a new window]   Figure 3.  Digital radiograph of a 4-year-old girl shows a locket that she had swallowed. It passed without difficulty. (Courtesy of Stephen Smyth, MD, University of Arizona, Tucson.)

View larger version (138K): [in a new window]   Figure 4.  Radiograph of a 15-year-old retarded child who had a history of repeatedly swallowing foreign objects shows a safety pin and a key in the jejunum and a rubber flexible Khrushchev doll head (arrow) in the descending colon. The objects passed without complications. (Courtesy of George Barnes, MD, University of Arizona, Tucson.)

View larger version (144K): [in a new window]   Figure 5.  Radiograph shows a pencil (arrows) lodged in the ascending colon. It passed without difficulty. It is unusual for such an elongated object to pass through the intestinal tract without problems.

View larger version (114K): [in a new window]   Figure 6.  Radiograph of an elderly patient demonstrates a coffee cup fragment (arrow) lodged in the distal esophagus.

View larger version (163K): [in a new window]   Figure 7a.  Scout view of the chest (a) and lateral view from a swallowing study (b) of an 18-month-old boy who was having difficulty keeping his food down and had a history of tracheoesophageal (TE) fistula repair show a coin lodged in his proximal esophagus. The coin was subsequently shown to be sitting above an esophageal stricture from his TE fistula repair.

View larger version (166K): [in a new window]   Figure 7b.  Scout view of the chest (a) and lateral view from a swallowing study (b) of an 18-month-old boy who was having difficulty keeping his food down and had a history of tracheoesophageal (TE) fistula repair show a coin lodged in his proximal esophagus. The coin was subsequently shown to be sitting above an esophageal stricture from his TE fistula repair.

View larger version (122K): [in a new window]   Figure 8a.  Radiograph (a) and images from a barium swallow study (b, c) of a 62-year-old man who accidently ingested a pill bottle cap while taking his medications demonstrate the cap (arrow in a) lodged in his proximal esophagus. It was removed at endoscopy. (Figure 8b and 8c reprinted, with permission, from reference 12).

View larger version (122K): [in a new window]   Figure 8b.  Radiograph (a) and images from a barium swallow study (b, c) of a 62-year-old man who accidently ingested a pill bottle cap while taking his medications demonstrate the cap (arrow in a) lodged in his proximal esophagus. It was removed at endoscopy. (Figure 8b and 8c reprinted, with permission, from reference 12).

View larger version (106K): [in a new window]   Figure 8c.  Radiograph (a) and images from a barium swallow study (b, c) of a 62-year-old man who accidently ingested a pill bottle cap while taking his medications demonstrate the cap (arrow in a) lodged in his proximal esophagus. It was removed at endoscopy. (Figure 8b and 8c reprinted, with permission, from reference 12).

View larger version (118K): [in a new window]   Figure 9.  Radiograph of an asymptomatic patient reveals metallic mercury in the appendix that resulted from rupture of the mercury bag on a Miller-Abbott tube.

View larger version (112K): [in a new window]   Figure 10.  Radiograph of a 72-year-old man with no gastrointestinal symptoms demonstrates BBs in the appendix. He used to eat BBs as a child.

View larger version (131K): [in a new window]   Figure 11a.  Sequential radiographs of a 4-year-old girl who ingested a watch battery show it first in the fundus of the stomach (a) and then later in the transverse colon (b). The battery passed without complications.

View larger version (139K): [in a new window]   Figure 11b.  Sequential radiographs of a 4-year-old girl who ingested a watch battery show it first in the fundus of the stomach (a) and then later in the transverse colon (b). The battery passed without complications.

View larger version (120K): [in a new window]   Figure 12.  Soft-tissue radiograph of a 1-year-old girl who was coughing after swallowing a red coinlike plastic wafer shows the object (arrowheads) lodged in her hypopharynx. She coughed it up a few minutes after the radiograph was taken. It is unusual for a plastic object to be opaque at radiography.

View larger version (153K): [in a new window]   Figure 13.  Radiograph of an 81-year-old man who swallowed a turkey bone shows the bone sliver (arrows) located just posterior to the calcified thyroid cartilage. The bone could not be seen at direct laryngoscopy but was removed at endoscopy.

View larger version (193K): [in a new window]   Figure 14.  Xeroradiograph of an elderly man with painful swallowing after eating a bowl of "oxtail" soup shows a prominent piece of impacted bone lying anterior to the 7th cervical vertebra. Note the prominently calcified posterior margin of the cricoid bone (arrow). This normal variant can easily be mistaken for a foreign body. The impacted fragment was removed from the proximal esophagus at endoscopy.

View larger version (133K): [in a new window]   Figure 15.  Radiograph of a 68-year-old man with difficulty in swallowing after eating fish shows a fish bone (arrow). Results of indirect laryngoscopy had been negative. The bone was removed at surgery following unsuccessful endoscopy. The bone had perforated the hypopharyngeal wall and was lodged in the soft tissues of the neck.

View larger version (98K): [in a new window]   Figure 16a.  (a) Radiograph of a 36-year-old woman with painful swallowing after eating chicken shows a small calcific opacity in her neck (arrowhead). (b) Radiograph obtained after the patient swallowed a barium capsule shows it temporarily lodged at the point of obstruction. A chicken bone was impacted in her proximal esophagus and removed at rigid endoscopy. (Figure 16b reprinted, with permission, from reference 34.)

View larger version (99K): [in a new window]   Figure 16b.  (a) Radiograph of a 36-year-old woman with painful swallowing after eating chicken shows a small calcific opacity in her neck (arrowhead). (b) Radiograph obtained after the patient swallowed a barium capsule shows it temporarily lodged at the point of obstruction. A chicken bone was impacted in her proximal esophagus and removed at rigid endoscopy. (Figure 16b reprinted, with permission, from reference 34.)

View larger version (117K): [in a new window]   Figure 17.  Image from a barium enema study of a 73-year-old woman shows a polyp in the descending colon. At endoscopy, the "polyp" proved to be an undigested mushroom. (Courtesy of Kiyoshi Ohsiro, MD, Okinawa, Japan.)

View larger version (138K): [in a new window]   Figure 18.  Radiograph of an 8-month-old boy with vague respiratory symptoms shows a twisted, thin linear opacity. A piece of wire was removed from his hypopharynx at endoscopy.

View larger version (118K): [in a new window]   Figure 19a.  Ingested foreign body in a 2-year-old girl with severe left-sided pneumonitis and empyema that required a tracheostomy. For several days, the ringlike metallic opacity noted on her portable chest radiographs was assumed to be associated with her tracheostomy tube. Standard frontal (a) and lateral (b) radiographs reveal a foreign body in the girl’s hypopharynx. A bingo chip was removed at endoscopy.

View larger version (110K): [in a new window]   Figure 19b.  Ingested foreign body in a 2-year-old girl with severe left-sided pneumonitis and empyema that required a tracheostomy. For several days, the ringlike metallic opacity noted on her portable chest radiographs was assumed to be associated with her tracheostomy tube. Standard frontal (a) and lateral (b) radiographs reveal a foreign body in the girl’s hypopharynx. A bingo chip was removed at endoscopy.

View larger version (115K): [in a new window]   Figure 20.  Radiograph of a 37-year-old mentally retarded woman who was admitted comatose with a 24-hour history of difficulty in breathing shows a safety pin. The pin had perforated the wall of her esophagus and penetrated her larynx. It was extracted at laryngoscopy, and she recovered without sequelae. Of incidental note is the prominent diffuse idiopathic skeletal hyperostosis (DISH) in the cervical spine.

View larger version (109K): [in a new window]   Figure 21a.  Frontal (a) and lateral (b) radiographs of a 13-year-old boy show a pin in his trachea. The boy had been playing with a blowgun and inhaled a corsage pin. It was removed at bronchoscopy. (Courtesy of George Barnes, MD.)

View larger version (121K): [in a new window]   Figure 21b.  Frontal (a) and lateral (b) radiographs of a 13-year-old boy show a pin in his trachea. The boy had been playing with a blowgun and inhaled a corsage pin. It was removed at bronchoscopy. (Courtesy of George Barnes, MD.)

View larger version (110K): [in a new window]   Figure 22a.  (a) First radiograph of an 8-year-old boy who was thought to have swallowed a foreign object shows no opaque object in the chest or stomach. The radiologist asked for a repeat radiograph to include all the abdomen and pelvis. (b) Second radiograph shows a metallic object in the child’s distal small bowel.

View larger version (120K): [in a new window]   Figure 22b.  (a) First radiograph of an 8-year-old boy who was thought to have swallowed a foreign object shows no opaque object in the chest or stomach. The radiologist asked for a repeat radiograph to include all the abdomen and pelvis. (b) Second radiograph shows a metallic object in the child’s distal small bowel.

View larger version (113K): [in a new window]   Figure 23.  Radiograph of a young child with a history of eating sand shows opacities from the sand in the bowel. (Courtesy of George Barnes, MD.)

View larger version (145K): [in a new window]   Figure 24a.  (a-c) Radiographs of three adults who were smuggling drugs show a packet (arrow) in the transverse colon (a) and relatively opaque packets in the transverse and descending colon (b, c). (d) Radiograph of an adult who was in the habit of swallowing rubber gloves shows a mottled lucent area (arrow) in the right lower quadrant of the abdomen. The finding represents a rolled-up rubber glove in the terminal ileum. It has a similar appearance to swallowed drug packets. (Fig 24a-24d courtesy of Charles A. Rohrmann, Jr, MD, University of Washington, Seattle.)

View larger version (165K): [in a new window]   Figure 24b.  (a-c) Radiographs of three adults who were smuggling drugs show a packet (arrow) in the transverse colon (a) and relatively opaque packets in the transverse and descending colon (b, c). (d) Radiograph of an adult who was in the habit of swallowing rubber gloves shows a mottled lucent area (arrow) in the right lower quadrant of the abdomen. The finding represents a rolled-up rubber glove in the terminal ileum. It has a similar appearance to swallowed drug packets. (Fig 24a-24d courtesy of Charles A. Rohrmann, Jr, MD, University of Washington, Seattle.)

View larger version (152K): [in a new window]   Figure 24c.  (a-c) Radiographs of three adults who were smuggling drugs show a packet (arrow) in the transverse colon (a) and relatively opaque packets in the transverse and descending colon (b, c). (d) Radiograph of an adult who was in the habit of swallowing rubber gloves shows a mottled lucent area (arrow) in the right lower quadrant of the abdomen. The finding represents a rolled-up rubber glove in the terminal ileum. It has a similar appearance to swallowed drug packets. (Fig 24a-24d courtesy of Charles A. Rohrmann, Jr, MD, University of Washington, Seattle.)

View larger version (168K): [in a new window]   Figure 24d.  (a-c) Radiographs of three adults who were smuggling drugs show a packet (arrow) in the transverse colon (a) and relatively opaque packets in the transverse and descending colon (b, c). (d) Radiograph of an adult who was in the habit of swallowing rubber gloves shows a mottled lucent area (arrow) in the right lower quadrant of the abdomen. The finding represents a rolled-up rubber glove in the terminal ileum. It has a similar appearance to swallowed drug packets. (Fig 24a-24d courtesy of Charles A. Rohrmann, Jr, MD, University of Washington, Seattle.)

View larger version (160K): [in a new window]   Figure 25.  Radiograph of a typesetter shows opaque lead visible within the rectosigmoid portion of his colon. The man had inadvertently ingested high amounts of metallic lead over a period of years while eating his lunch at the plant. He had very high lead levels in his blood, neurologic symptoms, anorexia, and constipation.

View larger version (123K): [in a new window]   Figure 26.  Radiograph of a 3-year-old boy demonstrates multiple iron tablets probably containing ferrous gluconate and ferrous sulphate salts. He recovered without sequelae. (Courtesy of George Barnes, MD.)

View larger version (124K): [in a new window]   Figure 27.  Radiograph shows bismuth subsalicylate (Pepto-Bismol) tablets in the right lower quadrant of the abdomen producing a "pseudoappendicolith" appearance. (Courtesy of Charles A. Rohrmann, Jr, MD.)

View larger version (132K): [in a new window]   Figure 28.  Radiograph of a young child shows a screw that she had inserted into her vagina.

View larger version (136K): [in a new window]   Figure 29.  Radiograph of a 2-year-old girl shows a bobby pin in her bladder. (Courtesy of George Barnes, MD.)

View larger version (180K): [in a new window]   Figure 30.  Radiograph of an elderly woman shows a "menstrual cup" (arrow) that she had inserted into her vagina.

View larger version (145K): [in a new window]   Figure 31.  Radiograph of a 15-year-old boy shows a rectal thermometer lying free in the peritoneum. Its origin was unknown. He denied inserting any foreign objects into his rectum or urethra. He had had no treatments or hospitalizations since he was 1 year old. (Courtesy of George Barnes, MD.)

View larger version (154K): [in a new window]   Figure 32.  Radiograph of a 19-year-old woman shows a bobby pin lodged in her uterus. She had attempted to induce an abortion with the pin. A subsequent self-inflicted abortion attempt was successful. (Courtesy of George Barnes, MD.)

View larger version (132K): [in a new window]   Figure 33.  Radiograph of a young woman demonstrates a labial ring. (Courtesy of Ken Sandock, MD, Tucson, Ariz.)

View larger version (137K): [in a new window]   Figure 34.  Radiograph of an 18-year-old man demonstrates bladder calculi that had formed on fine telephone wire. Six months before, he lost the wire in his bladder when he achieved an erection while inserting the wire into his urethra during masturbation. (Courtesy of George Barnes, MD.)

View larger version (121K): [in a new window]   Figure 35.  Radiograph of a 60-year-old man demonstrates a condensed milk can that he had inserted into his rectum. (Courtesy of George Barnes, MD.)

View larger version (167K): [in a new window]   Figure 36.  Radiograph of a 51-year-old man who first declined to give a history other than "rectal pain" shows a bottle of gargling liquid in a Hartman pouch. Three weeks before this admission, he had undergone colon surgery to remove an impacted shampoo bottle in his distal colon. A Hartman pouch was constructed for him at that time. (Courtesy of Tyler Gibb, MD, Tacoma, Wash.)

View larger version (181K): [in a new window]   Figure 37a.  (a, b) Initial frontal and lateral CT scout views of a young man who accidentally shot himself in the chest and right arm with a shotgun show multiple shotgun pellets in the right shoulder and right anterior chest wall. Note the pellet overlying the heart inferiorly on the lateral view. (c) CT image of the lower portion of the chest shows the inferior pellet in the right ventricle. It had penetrated the right subclavian vein and embolized to the right ventricle. It was visible bouncing in the right ventricle when fluoroscopy was performed during right upper extremity angiography. The pellet was successfully removed at cardiac catheterization. (Courtesy of Michael Rosellini, MD, Portland, Ore.)

View larger version (160K): [in a new window]   Figure 37b.  (a, b) Initial frontal and lateral CT scout views of a young man who accidentally shot himself in the chest and right arm with a shotgun show multiple shotgun pellets in the right shoulder and right anterior chest wall. Note the pellet overlying the heart inferiorly on the lateral view. (c) CT image of the lower portion of the chest shows the inferior pellet in the right ventricle. It had penetrated the right subclavian vein and embolized to the right ventricle. It was visible bouncing in the right ventricle when fluoroscopy was performed during right upper extremity angiography. The pellet was successfully removed at cardiac catheterization. (Courtesy of Michael Rosellini, MD, Portland, Ore.)

View larger version (140K): [in a new window]   Figure 37c.  (a, b) Initial frontal and lateral CT scout views of a young man who accidentally shot himself in the chest and right arm with a shotgun show multiple shotgun pellets in the right shoulder and right anterior chest wall. Note the pellet overlying the heart inferiorly on the lateral view. (c) CT image of the lower portion of the chest shows the inferior pellet in the right ventricle. It had penetrated the right subclavian vein and embolized to the right ventricle. It was visible bouncing in the right ventricle when fluoroscopy was performed during right upper extremity angiography. The pellet was successfully removed at cardiac catheterization. (Courtesy of Michael Rosellini, MD, Portland, Ore.)

View larger version (167K): [in a new window]   Figure 38.  Transverse US image of an elderly man shows a bullet (arrow) in his liver. The man had a history of a gunshot wound many years ago, and the bullet was found incidentally, since the examination of his liver had been performed for another reason.

View larger version (113K): [in a new window]   Figure 39.  Radiograph of a young man who stepped on a nail while wearing sandals shows the nail in the soft tissues of his foot. The radiograph was obtained to see if the nail had entered his calcaneus.

View larger version (165K): [in a new window]   Figure 40a.  Clothes and jewelry on a patient may simulate a foreign body injury as illustrated by the frontal (a) and lateral (b) radiographs of the chest of a woman whose bra was packed with metallic shot to make her breasts appear larger. (Courtesy of Ken Sandock, MD.)

View larger version (143K): [in a new window]   Figure 40b.  Clothes and jewelry on a patient may simulate a foreign body injury as illustrated by the frontal (a) and lateral (b) radiographs of the chest of a woman whose bra was packed with metallic shot to make her breasts appear larger. (Courtesy of Ken Sandock, MD.)

View larger version (120K): [in a new window]   Figure 41.  Lateral radiograph of the left tibia and fibula in a 22-year-old man shows a lucent area (arrows) in his soft tissues that outlines a large piece of wood. The man had been assaulted with a wooden stake, a portion of which broke off in his left calf.

View larger version (103K): [in a new window]   Figure 42.  Radiograph of a 17-year-old boy shows barnacle fragments in his left heel. The boy had been water skiing and came in on the dock and unexpectedly encountered barnacles, pieces of which lodged in his heel. Glass fragments would have a similar appearance. (Courtesy of George Barnes, MD.)

View larger version (96K): [in a new window]   Figure 43.  Radiograph of a young woman demonstrates pieces of glass in her leg secondary to an automobile accident.

View larger version (131K): [in a new window]   Figure 44a.  (a) US image shows two small echogenic lesions (1 and 2) in a physician who had had frequent steroid injections in his left knee prepatellar bursa and who developed a small tender palpable abnormality. The echogenic lesions proved to be calcific deposits and were removed at surgery. (b) US image of a young man who stepped on a broken mesquite tree branch shows a small echogenic foreign body (cursors). At first presentation, a large wooden fragment that pierced his foot was successfully removed, but he continued to have pain and swelling over the dorsum of his foot. The foreign body seen at US proved to be a mesquite thorn and was removed at surgery.

View larger version (149K): [in a new window]   Figure 44b.  (a) US image shows two small echogenic lesions (1 and 2) in a physician who had had frequent steroid injections in his left knee prepatellar bursa and who developed a small tender palpable abnormality. The echogenic lesions proved to be calcific deposits and were removed at surgery. (b) US image of a young man who stepped on a broken mesquite tree branch shows a small echogenic foreign body (cursors). At first presentation, a large wooden fragment that pierced his foot was successfully removed, but he continued to have pain and swelling over the dorsum of his foot. The foreign body seen at US proved to be a mesquite thorn and was removed at surgery.

View larger version (163K): [in a new window]   Figure 45a.  (a) Supine abdominal view of a 25-year-old woman who had recently undergone a cesarean section in Mexico and who presented with abdominal pain and fever shows a large complex, partially lucent, left flank mass (arrow) with an associated linear opacity. (b) Close-up view shows the mass and linear opacity. At surgery, there was a retained surgical sponge with a surrounding area of granuloma formation, a gossypiboma.

View larger version (148K): [in a new window]   Figure 45b.  (a) Supine abdominal view of a 25-year-old woman who had recently undergone a cesarean section in Mexico and who presented with abdominal pain and fever shows a large complex, partially lucent, left flank mass (arrow) with an associated linear opacity. (b) Close-up view shows the mass and linear opacity. At surgery, there was a retained surgical sponge with a surrounding area of granuloma formation, a gossypiboma.

View larger version (129K): [in a new window]   Figure 46a.  Radiographs of a 21-year-old man who injected himself with metallic mercury demonstrate emboli to the lungs (a, b) and residual mercury deposits in his left antecubital fossa (c). (Case courtesy of Charles A. Rohrmann, Jr, MD.) (Figure 46a and 46b reprinted, with permission, from reference 82.)

View larger version (136K): [in a new window]   Figure 46b.  Radiographs of a 21-year-old man who injected himself with metallic mercury demonstrate emboli to the lungs (a, b) and residual mercury deposits in his left antecubital fossa (c). (Case courtesy of Charles A. Rohrmann, Jr, MD.) (Figure 46a and 46b reprinted, with permission, from reference 82.)

View larger version (126K): [in a new window]   Figure 46c.  Radiographs of a 21-year-old man who injected himself with metallic mercury demonstrate emboli to the lungs (a, b) and residual mercury deposits in his left antecubital fossa (c). (Case courtesy of Charles A. Rohrmann, Jr, MD.) (Figure 46a and 46b reprinted, with permission, from reference 82.)

View larger version (113K): [in a new window]   Figure 47.  Radiograph of trick-or-treat candy reveals no hidden needles or razor blades. The candy and apple were eaten without problems. Can you identify the various objects?

View larger version (145K): [in a new window]   Figure 48a.  (a) Axial three-dimensional MR arthrogram of the left shoulder in a 40-year-old man being evaluated for recurrent rotator cuff injury after prior rotator cuff repair shows several signal void areas (arrows) from tiny metallic deposits in the shoulder as a result of the past surgery. Radiographic findings were normal. (b) Coronal T1-weighted image of a 5-year-old girl with a history of posttraumatic and postsurgical changes of the right ankle and foot involving the distal tibia, talus, and navicular shows marked image distortion from signal void areas (arrows) caused by multiple microscopic metallic artifacts deposited at prior surgery. Radiographs did not show visible metallic opacities.

View larger version (116K): [in a new window]   Figure 48b.  (a) Axial three-dimensional MR arthrogram of the left shoulder in a 40-year-old man being evaluated for recurrent rotator cuff injury after prior rotator cuff repair shows several signal void areas (arrows) from tiny metallic deposits in the shoulder as a result of the past surgery. Radiographic findings were normal. (b) Coronal T1-weighted image of a 5-year-old girl with a history of posttraumatic and postsurgical changes of the right ankle and foot involving the distal tibia, talus, and navicular shows marked image distortion from signal void areas (arrows) caused by multiple microscopic metallic artifacts deposited at prior surgery. Radiographs did not show visible metallic opacities.