Timely detection of intraorbital and skull base wooden foreign bodies is crucial. For this reason we investigated plain film, ct and mri sensibility in the evaluation of ifb. Request pdf screening for intraorbital metallic foreign bodies prior to mri. Although it is rare, a retained intraorbital foreign body iofb is often a result of highvelocity projectile trauma with a sharptipped object. Magnetic resonance imaging may be difficult to perform emergently. Extraconal orbital lesions include lesions which arise from structures within the extraconal orbital space and those extending from adjacent structures into the orbits. Intra orbital foreign body iofb reporting for radiographers.
Undetected intraocular metallic foreign body causing hyphema in a patient undergoing mri. This modality cannot be used initially in cases with suspected foreign body. Mri is sophisticated, expensive and not widely available. The hospital neurosurgeon was consulted and a magnetic resonance imaging mri scan was requested.
Extraconal orbital lesions radiology reference article. Highspeed foreign bodies are more likely to penetrate the globe, whereas lowspeed ones such as twigs are more likely to spare the globe. Remember that a positive result does not mean that an infection is occurring and that a negative result does not preclude the possibility of endophthalmitis. Great for the radiology resident who need a general mri book that will cover a lot of ground on a lot of topic while staying thin and affordable.
Computed tomography ct is considered to be the top choice for evaluating orbital trauma. To emphasise the need for careful selection of mri and or usg along with ct scan when investigating for an intraorbital foreign body, especially of the. In this case, preoperative assessment of the precise location of the foreign body was important for surgical treatment planning. Intraocular foreign body an overview sciencedirect topics. An intraorbital injury from an occult wooden foreign body. Two of these cases had only plain xrays, and one patient with a clear history of a wooden foreign body had orbital ultrasonography and a magnetic resonance imaging mri scan. Intraorbital wooden foreign body, diagnosed by nmr and ultrasonography, and extirpation by cranioorbital approach.
November 2014 brief communications 1099 foreign body. Your next action is with this five days out, new swelling a, repeat the mri, a repeat mri is needed to find the retained foreign body. B, ascan shows thick 100% high spike from foreign body and decreased signals from sclera and orbit arrows due to sound attenuation. Ct scan is also useful in detection of associated injury like vitreous haeomorrgae, bony orbital wall injury. The imaging appearance of wooden foreign bodies is variable. Siegelmans body mri book is one of the best mri introduction out there. Screening for intraorbital metallic foreign bodies prior to. Papers concerning plain film and ct sensibility in ifb detection show controversial results. Coronal view in bone window with definition of the foreign body in the inferior and lateral intraconal area perforation le with intraorbital foreign body. Intraorbital foreign body projectile as a consideration for.
In contrast, orbfbs are lodged within the walls of the. We report the case of an asymptomatic 47 yearold male patient who suffered a penetrating wound from a metallic foreign body that became embedded adjacent to the optic nerve for over thirty years, as well as the associated examination, imaging, and fundus photography. Differential diagnosis intraorbital lesions dermoid cyst. Missed diagnosis of a wooden intraorbital foreign body. So a metallic foreign body located deep in the posterior orbit may be only observed and given appropriate supportive care, thus. The university of queenslands institutional repository, uq espace, aims to create global visibility and accessibility of uqs scholarly research. Intraocular and intraorbital foreign bodies characteristics in patients with penetrating ocular injury. It is possible, that in this case longtime occupy foreign body in the orbita was a cause of that tumor. The comparative accuracy of radiolucent foreign body detection using ultrasonography. With ct or mri, accurate foreign body localization is possible. Intraorbital foreign body detection and localisation by. Visibility of different intraorbital foreign bodies using. The term refers to a foreign body that occurs within the orbit but outside the globe. Retained intraorbital metallic foreign bodies are welltolerated and does not cause much impact on visual deterioration, thus they should be managed conservatively in the absence of specific indications for removal.
Delivered by an experienced teaching team and accredited by the college of radiographers, cpd continuing professional development now scheme, this intra orbital foreign body iofb reporting study day aims to enhance imaging service provision by equipping you with the skills required to interpret orbital xrays as part of the mri screening process. The percentage of water content may be different in each case reported so far. An mri scan may be performed as the primary imaging modality if there is a definite. Intraocular foreign body iofb injuries vary in presentation, outcome, and prognosis depending upon various factors. A rare case of a glass foreign body in the parapharyngeal. Intraorbital wooden foreign bodies can be difficult to detect. Introduction the purpose of this study was to run a preliminary investigation to establish if a short course of learning would increase radiographers performance in intraorbital foreign body iofb detection and localisation on pre magnetic resonance imaging mri orbital computed radiographs cr. An absolute contraindication to mri is the presence of a metallic foreign body in the globe. Review of the evidence magnetic resonance imaging of patients with a metallic intraorbital foreign body iofb. The initial mri did not show retained foreign body. Nevertheless, ct and mr imaging are complementary modalities. If ct is used for screening, care should be taken to use thin slices and no interslice skip. Management of an unusual orbitocranial penetrating injury.
Imaging is of crucial importance while managing foreign bodies which include ct and magnetic resonance imaging mri scans and intraoperative image intensifiers, which help determine foreign body location and its topographic relationships with neighboring structures e. Visibility of different intraorbital foreign bodies using plain radiography, computed tomography, magnetic resonance imaging, and conebeam computed tomography. An intraorbital metallic foreign body pubmed central pmc. A 33yearold man who suffered an accident axial view of the inferior orbit demonstrates the location of the foreign body as retrobulbar in the intraconal area. Clinical features and management of intraorbital foreign. The detailed inspection of the nasal cavity revealed a small foreign body that could easily be removed by colleagues from our ear nose throat ent. Investigation of a case of suspected wooden foreign body in the orbit should include an mri scan if there is no contraindication, and no foreign body has been defined on ct. Radiographs and ct scans were used to identify and localize intraorbital foreign bodies. Case presentation a 41yearold male patient presented with a complaint of swelling on the left upper eyelid since 5 months with no ocular complaints. Under general anesthesia, left lateral eyebrow incision was given exposing the supra. Culture an intraocular foreign body iofb or a sample of vitreous if an infection is suspected. The purpose of this study is to build a database to do comparison studies of epilepsy patients and normal controls with magnetic resonance imaging mri and electroencephalogram eeg. More than what meets the eyedelayed presentation of orbital. Optic atrophy induced by an intraorbital wooden foreign.
Health, general eye health aspects foreign bodies care and treatment case studies diagnosis foreign bodies medical care. The mri revealed a long, linear orbital foreign body extending from the left orbit through the medial part of the temporal lobe up to the brain stem figure 2. Retained intraorbital wooden foreign bodies may lead to complications such as prolonged suppuration with a draining fistula, foreign body granuloma, orbital cellulitis, abscess formation, panophthalmitis, extraocular muscle damage, exophthalmos and even brain abscesses 4,5. Intraorbital wood detection by magnetic resonance imaging beth f. Failure to remove an unsterile foreign body is likely to result in an intraorbital or intracranial abscess, or an externally draining sinus figure 14. Metallic foreign bodies in the orbits of patients undergoing. No imaging modality, be it a ct or mri, can detect a wooden foreign body with 100% sensitivity. Mri showed a welldelineated lowintensity lesion suggestive of a retained foreign body. Delivered by an experienced teaching team and accredited by the college of radiographers, cpd continuing professional development now scheme, this intraorbital foreign body iofb reporting study day aims to enhance imaging service provision by equipping you with the skills required to interpret orbital xrays as part of the mri screening. Wooden intraorbital foreign bodies present a unique radiologic diagnostic challenge due to their varied appearance with different imaging modalities and other factors including size, shape, porosity, type, density, and especially whether the foreign body is wet or dry.
More than what meets the eyedelayed presentation of orbital foreign body. Contraindicated for suspected metallic foreign body. The visual prognosis depends on the zone of injury, type and size of foreign body causing the injury and. The best protocol is to obtain thinsection axial ct scans, then to per. May 18, 2017 intraocular foreign bodies iofbs are rather variable in presentation, outcome, and prognosis. Optic atrophy induced by an intraorbital wooden foreign body. Superior soft tissue resolution can help in identification of some wooden foreign bodies. Wooden foreign bodies are difficult to detect on imaging. To emphasise the need for careful selection of mri andor usg along with ct scan when investigating for an intraorbital foreign body, especially of the ferrous nature.
Med j malaysia vol 66 no 4 october 2011 361 an unusual entry site of an intraorbital foreign body in a child p s mallika, mbbs, ms ophthalmology, y j chong, mbbs, a k. Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Mri is contraindicated if a metallic foreign body is suspected, and never the initial study of choice. Metallic orbital foreign body on mri radiology case. Longterm retention of an intraorbital metallic foreign body. It should be reserved for high suspicion of wooden iorbfbs or fragments foreign body was stuck prior to the mri examination and the localized lens opacity at the.
Unusual intraorbital foreign body bmj case reports. Intraorbital foreign bodies are frequently the result of highvelocity injuries with varying clinical presentations. The resultant diagnosis, management, and outcome depend on the type of foreign body present, anatomical location, tissue disruption, and symptomatology. In conclusion, we believe that intraorbital wooden foreign bodies may be detected by mri tsaloumas et al. Intraorbital foreign bodies orbfbs are a common complication of ocular trauma. Mri is useful for detection of nonmetallic foreign bodies. Management of intraorbital foreign bodies ophthalmic pearls trauma i ntraorbital foreign bodies orbfbs are a common complication of ocular trauma. With increased awareness and advanced surgical techniques, the outcome and the prognosis for these potentially devastating injuries have substantially improved. A patient who presented to the emergency department with a large intraorbital foreign body projectile that was not evident.
Eyelid lacerations are considered complicated when they are fullthickness or involve a ruptured globe, intraorbital foreign body, the lacrimal draining system, the levator aponeurosis or superior rectus muscle, damage to the lid margin, visible orbital fat prolapse, medial canthal tendon rupture, or extensive tissue loss and should be repaired. Management of intraorbital foreign bodies american. Optimising this process can improve efficiency and resource management. Computed tomography ct revealed an intraorbital foreign body. A total of 1593 patients who had identified themselves as being at risk for an intraorbital metallic foreign body had undergone plain radiography or ct of the orbits. Increased awareness about eye protection, improved surgical techniques, and advancements in bioengineering are responsible for an improved outcome in injuries with iofb. The radiologist may fail to identify wooden foreign bodies on two thirds of initial scans and can miss them in almost one third of total cases. Intraocular foreign bodies iofbs are foreign bodies that have penetrated the eye and are lodged within the globe. Ct scan remains a standard investigation used to visualize intraorbital foreign bodies, although with organic foreign bodies, its results may be inconclusive. Computed tomographic ct scans were performed in all but three cases. Mri may be a helpful adjunct to ct once metallic foreign bodies are ruled out. In these cases, patients may complain of a progressive orbital mass, signs of orbital inflammation and infection, pain on eye movements, diplopia, andor lagophthalmos.
Of crucial importance are also ct and mri scans, which help determine foreign body location and its topographic relationships with neighboring structures e. The magnetic fields in mri lead to the need to screen patients for metallic intra orbital foreign bodies. In contrast, orbfbs are lodged within the walls of the orbit, which creates a risk of damage to surrounding structures, such as the extraocular muscles and cranial nerves ii through vi. Intraorbital foreign body accompanied by sclopetaria. Pdf intraorbital wooden foreign body, diagnosed by nmr and. Orbital x ray is also used as a screening tool before an mri is performed, since intraorbital metallic foreign bodies are a contraindication for mri the magnetic field in the mri could move the metallic object causing eye injury.
The failure to detect a metallic foreign body before mri may result in globe perforation and blindness should the metallic foreign body move during imaging. The clinical history, physical exam, and imaging are helpful in planning the surgical approach for patients with iofbs. Magnetic resonance imaging mri should never be the initial imaging modality. Intraorbital wooden foreign body on mri 2 years after injury. Plain film, ct and mri sensibility in the evaluation of intraorbital foreign bodies in an in vitro model of the orbit and in pig eyes. Visibility of different foreign bodies in the maxillofacial. Intraorbital foreign bodies may be found with double penetrating globe injuries due to high velocity particles eg, missiles where the foreign body settles in the orbit and can be detected by. Radiographic studies and ct may fail to identify their presence.
We present a case of an intraorbital wood foreign body that required two. Trauma cases that apparently seem minor with no visibly protruding. Ryan prall, md, and photographed by tom egnatz, cra, eugene and marilyn. An unexpected ferromagnetic foreign body detected during. Intraorbital fat has high signal on the proton density and t2weighted fast spinecho images and therefore serves as a good background to delineate hypointense wooden foreign bodies. Sep 01, 2002 an intraorbital injury from an occult wooden foreign body. Intraorbital wooden foreign body mimicking air at ct. This study day presents an opportunity for participants to increase their knowledge and skills in. Intraorbital metallic foreign bodies can be well tolerated and may not require surgical intervention despite proximity to. In one case we found coexistence foreign body shot and tumor inflammation pseudotumor of the orbita. Management of intraorbital foreign bodies american academy. The patient was a 50yearold caucasian man whose face was injured on the right side while he was working with an agricultural machine. An ophthalmologist may also order orbital x rays when a foreign body cannot be detected with an ophthalmoscope.
Detection and characterization of intraorbital foreign bodies ifb is fundamental in acute trauma setting, preventing inflammatory sequelae or complications related to ifb movements when a mri study is planned. Ct is more accurate, 9 particularly when a nonopaque object is anticipated 11 or the foreign body is located inside pneumatized areas. Therefore a ferromagnetic foreign body in either mouth or nose was suspected and the child was removed from the mri scanner. Here, we report a rare case of a glass foreign body lodged in the parapharyngeal space, where many important vessels including the internal carotid artery and internal jugular vein are found. These are better seen with magnetic resonance imaging mri. Zhang et al 29 recently reported that ct can fail to detect metal fragments mri identified these tiny metallic fragments without an adverse outcome. A n intraorbital foreign body is an important cause of ocular morbidity especially in the peadiatric and adolescent age groups. Update on the management of intraocular foreign bodies. Between 20,000 and 68,000 serious visionthreatening ocular injuries occur in the united states every year. In the acute stage, it appears as a hypodense linear or cylindrical welldemarcated focus and becomes surrounded by hyperdense inflammatory tissue in the chronic stage. Trauma cases that apparently seem minor with no visibly protruding objects can still retain intraorbital wooden foreign bodies. The other 24 patients had metallic foreign bodies adjacent to or within the globe and were thought to be at risk for movement of the metallic foreign body as a result of mr imaging. Intraocular foreign body iofb cases are challenging and can have variable visual outcomes. In this case there was extreme concern on the initial mri imaging it was immediately terminated on seeing this artefact, but fortunately ct showed the metal to be outside the globe and the patient suffered no illeffects.
Nov 18, 2014 a quick inspection revealed no obvious foreign object in the facial region. Mri allows for visualization and precise identification of foreign bodies, which is vital for surgery. Sep 03, 2007 these are better seen with magnetic resonance imaging mri. Delayed presentation may occur after seemingly trivial trauma. The prevalence of intraorbital metallic foreign bodies in our study population was low 0. Sonography is frequently underused but proved most useful for the evaluation of retained wooden foreign. However, an mri is contraindicated if the suspected foreign body is ferromagnetic. In addition, fast spinecho allows shorter scan time than standard conventionalspinecho.
Retained intraorbital wooden foreign body presenting with. Is there a place for steroids in the management of patients with intraorbital foreign bodies to adjunctive. The diagnostic process of intraorbital foreign bodies should include history taking, physical examination, and a variety of plain radiograph projections. C, foreign body spike remains highly reflective even at a very low sensitivity setting. Case report, case study by journal of evolution of medical and dental sciences. Note the marked shadowing s just posterior to the foreign body. Itraorbital organic foreign body radiological methods in.
Bmode ultrasound revealed medium amplitude echoes through out the vitreous with attached retina. An unusual entry site of an intraorbital foreign body in a. In a patient with a surgicallyimplanted foreign body, mri becomes more challenging but remains highly useful in evaluating for complications 25, 26, 27 despite its ability to provide excellent contrast resolution, mri can be hindered by artifact secondary to metallic implants, screws, staples and metallic shavings. It is critical that mri only be performed after a metallic intracranial, intraorbital, or intraocular foreign body has been ruled out by ct scanning or conventional radiography. We report a case of a workrelated accident involving a periorbital foreign body. Unusual presentation of more common diseaseinjury unusual. Intraorbital foreign body university college dublin. A study to gather a database of normal and epilepsy brain. Department of plastic reconstructive and aesthetic surgery, trakya university faculty of medicine, edirne.
Unusual intraorbital foreign body pubmed central pmc. Once an intraorbital foreign body is diagnosed, appropriate management includes culture of the wound or foreign body if removed and administration of antibiotics. These properties of wood are dissimilar enough from those of the soft tissue to allow differentiation. From there you will be able to build further with more advanced texts and published articles. Background penetrating orbitocranial injury carries high mortality and morbidity. A collection of the most interesting xrays of things that dont belong and the stories behind how they got there. Feb 25, 2007 these properties of wood are dissimilar enough from those of the soft tissue to allow differentiation. In contrast, orbfbs are lodged within the walls of the orbit, which creates a risk of damage to surrounding structures, such as the extraocular.
489 611 595 240 1595 1123 868 80 1002 1343 1387 338 1543 763 1611 171 993 244 1503 1059 1161 664 628 751 549 589 608 1200 583 223 856 1045 697