•Foreign Body
Soft Tissues
Causes are various, imaging is frequently pursued to assess for damage to deeper structures
•Foreign Body
Gunshot Wound (GSW)
Whole bullets may be seen
•Gunshot Wound (GSW)
Bullets may be obvious on CT due to the starburst pattern (artifact)
The bullet tract may also be visible
•Foreign body in eye
(Gross)
Special note: Mercifully, the body frequently has “2” of most things. A good general check is to compare left to right and notice any differences (easy way to pick up pathologies)
Timing – Imaging ProTip
•What if I just had imaging?
•This can be used (if “recent enough” – and that is up to your discretion as the physician) as a data-point for your decisions.
Example: Pt presented to the ED yesterday with a headache, had a CT scan, was discharged, but presented to the ED again today because the headache didn’t go away. They may not need to repeat the scan.
•If there are any “changes” since the last scan (by history or by exam), it’s not unreasonable to get a repeat scan regardless of when the last one was.
Example: Pt presented to the ED yesterday with a headache, had a CT scan, was discharged, but presented to the ED again today with worsening headache, vomiting, visual changes, and slurred speech… (we should repeat the scan).
•Symptoms were treated and the patient showed some improvement…
However, they returned and again persisted.
•Repeat imaging in mid-April was pursued
(~6 weeks after the first scan)
Radiology Read (April 18 Scan)
•IMPRESSION:
•Current examination without acute intracranial hemorrhage or clear evidence of brain ischemia.
•Comparison with March 8 CT examination shows interval development of scattered areas of nodular thickening of the ependymal at the lateral ventricles and also at septum pellucidum; primary diagnostic consideration is intracranial metastatic disease.
•Concern of focal lesions of sub-centimeter size at the left aspect of the cerebellum and involving the left posterior lateral brain stem; concern of intracranial metastatic disease.
•MRI examination of the brain with IV contrast for further assessment advised.
•Remote/old infarct at left occipital lobe.
Note: Radiology made recommendations for MRI imaging to further assess (these kinds of suggestions are fantastic and nearly always get completed).