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Digital tomosynthesis for detection of ingested foreign objects in the emergency department: a case of razor blade ingestion

  • Maham JehangirEmail author
  • Christopher Mallory
  • Jonathan R. Medverd
Case Report

Abstract

A 46-year-old schizophrenic male presented to the emergency department (ED) after deliberate ingestion of an undetermined number of open razor blades. Abdominal radiograph revealed one razor blade but raised suspicion of a second blade which was subsequently confirmed by digital tomosynthesis (DTS), seen as two razor blades superimposed upon each other placed at slightly different angles. A careful search was made during endoscopy and the two razor blades were retrieved from the stomach and duodenum, respectively. This case illustrates the use of digital tomosynthesis as a smart, timely, cost-effective, and low-dose alternative to conventional computed tomography (CT) that can be conveniently employed in the ED for foreign body localization.

Keywords

Digital tomosynthesis Foreign body ingestion Abdominal X-ray Razor blade 

Notes

Acknowledgements

We thank Jeffrey Dunnam and Jeff Fox, Lead Technologists, Emergency Radiology, Harborview Medical Center, for generously assisting in the preparation of some of the images and related technical parameters for this article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Palta R, Sahota A, Bemarki A, Salama P, Simpson N, Laine L (2009) Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion. Gastrointest Endosc 69(3):426–433CrossRefGoogle Scholar
  2. 2.
    Guelfguat M, Kaplinskiy V, Reddy SH, DiPoce J (2014) Clinical guidelines for imaging and reporting ingested foreign bodies. AJR Am J Roentgenol 203(1):37–53CrossRefGoogle Scholar
  3. 3.
    Maravilla KR, Murry RC Jr, Horner S (1983) Digital Tomosynthesis: technique for electronic reconstructive tomography. AJR Am J Roentgenol 141(3):497–502CrossRefGoogle Scholar
  4. 4.
    Dobbins JT III, Godfrey DJ (2003) Digital x-ray tomosynthesis: current state of the art and clinical potential. Phys Med Biol 48(19):R65–R106CrossRefGoogle Scholar
  5. 5.
    Machida H, Yuhara T, Tamura M, Ishikawa T, Tate E, Ueno E, Nye K, Sabol JM (2016) Whole-body clinical applications of digital tomosynthesis. RadioGraphics 36(3):735–750CrossRefGoogle Scholar
  6. 6.
    Johansen A, Conners GP, Lee J, Robinson AL, Chew WL, Chan SS (2018) Pediatric esophageal foreign body: possible role for digital tomosynthesis. Pediatric Emerg Care.  https://doi.org/10.1097/PEC.0000000000001517
  7. 7.
    Omori T, Nakamura S, Shiratori K (2015) Localization of the patency capsule by abdominal tomosynthesis. Digestion 91(4):318–325CrossRefGoogle Scholar
  8. 8.
    Liu S, Wang H, Feng W, Hu X, Guo J, Shang Q, Li Z, Yu H (2018) The value of X-ray digital tomosynthesis in the diagnosis of urinary calculi. Exp Ther Med 15(2):1749–1753Google Scholar
  9. 9.
    Mermuys K, De Geeter F, Bacher K, Van De Moortele K, Coenegrachts K, Steyaert L, Casselman JW (2010) Digital tomosynthesis in the detection of urolithiasis: diagnostic performance and dosimetry compared with digital radiography with MDCT as the reference standard. AJR Am J Roentgenol 195(1):161–167CrossRefGoogle Scholar
  10. 10.
    Koyama S, Aoyama T (2010) Radiation dose evaluation in tomosynthesis and C-arm cone-beam CT examinations with an anthropomorphic phantom. Am Assoc Phys Med 37:4298–4306Google Scholar
  11. 11.
    Alshamari M, Norrman E, Geijer M, Jansson K, Geijer H (2016) Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review. Eur Radiol 26:1766–1774CrossRefGoogle Scholar
  12. 12.
    Gohmann RF, Heckner F, Uschner D, Kuhl CK, Reinartz SD (2017) Body pushers: low-dose CT, always the best choice? A study of the diagnostic performance of CT scout view. Open J Radiol 7:112–120CrossRefGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology, Harborview Medical CenterUniversity of WashingtonSeattleUSA
  2. 2.School of MedicineUniversity of WashingtonSeattleUSA

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