Rostad Bradley,  Richer Edward,  Riedesel Erica,  Alazraki Adina

Final Pr. ID: Paper #: 026

Foreign body ingestion is common in children. Timely diagnosis of the nature and location of the foreign body is important. A button battery which lodges in the esophagus can quickly cause severe esophageal and mediastinal injury. Machine learning that can detect anatomical regions of interest is an important step in computerized foreign body localization and may result in prioritization of radiographs with mediastinal foreign bodies. The purpose of this study is to develop a machine learning model to identify anatomical regions of interest on pediatric foreign body series radiographs. Read More

Authors:  Rostad Bradley , Richer Edward , Riedesel Erica , Alazraki Adina

Keywords:  Machine learning, Artificial intelligence, Foreign body

Chan Alvin,  Lin Jonathan,  Ghahremani Shahnaz,  Chawla Soni

Final Pr. ID: Poster #: EDU-039

Children, especially toddlers, are the most frequent victims of foreign body (FB) ingestion because of their natural curiosity, tempting them to put everything into their mouths. Anything within arm’s reach is fair game, from simple coins to the more dangerous button batteries and magnets. This study aims to provide a thorough review of plain radiographic findings of a myriad of foreign bodies (FBs) and associated complications. With the “Rule of 3–5”, we aim to help radiologists and clinicians develop a rationale and systematic approach in managing FB ingestions. Read More

Authors:  Chan Alvin , Lin Jonathan , Ghahremani Shahnaz , Chawla Soni

Keywords:  Foreign Body

Youssfi Mostafa

Final Pr. ID: Poster #: CR-062

Esophageal radiolucent foreign bodies can be overlooked in infants since the symptoms are usually nonspecific. Chest X-Rays are often the initial diagnostic tool. The lateral view is key since it may reveal anterior bowing and/or focal narrowing of the intra-thoracic trachea which should alert the radiologist to the possibility of radiolucent esophageal foreign body and the need for an Esophagram. We present two cases that illustrate the importance of this radiographic finding. Read More

Authors:  Youssfi Mostafa

Keywords:  Esophageal, Radiolucent, Foreign Body

Lin Jonathan,  Chawla Soni

Final Pr. ID: Poster #: EDU-040

Fidget spinners (FS) have become an increasingly popular toy among children of all ages since April 2017. This toy comprises of a central bearing attached to two or more prongs made of plastic or metal and is designed to be spun between a user’s fingers. With its popularity, FS have grown diverse in design, featuring additional components including light-emitting diode units, Bluetooth speakers, and button batteries. With its multiple small components, FS pose a risk of ingestion and aspiration among young children. This may be incidental or accidental due to the rapidly spinning nature of the toy. Since May 2017, there has been a growing number of cases of FS ingestions among young children internationally. Recognition of the different components of a FS on imaging, especially plain radiography, is important in the early diagnosis and prompt and accurate management of foreign body ingestion. To date, there is no available educational resource to aid and guide radiologists and clinical providers in identifying FS as a foreign body. The purpose of this educational exhibit is to assist radiologists and clinicians to identify the imaging findings associated with FS-related foreign body ingestions. Read More

Authors:  Lin Jonathan , Chawla Soni

Keywords:  Foreign Body, Fidget Spinner

Finkle Joshua,  Feinstein Kate

Final Pr. ID: Poster #: EDU-026

Kids put all sorts of things in their mouths. Foreign body ingestion is a common occurrence in children, and diagnostic imaging plays an important role in determining the nature of the foreign body and the need for emergent removal.

This presentation uses a question and answer format to provide high-yield clinically relevant information on the most commonly encountered foreign bodies including management guidelines for things like coins, batteries, and magnets. Both GI and airway foreign bodies are discussed. The presentation is catered mostly to trainees, but even experienced radiologists will enjoy challenging themselves to identify uncommon foreign bodies on imaging. Read More

Authors:  Finkle Joshua , Feinstein Kate

Keywords:  Foreign Body

Mcallister Aaron,  Lall Neil

Final Pr. ID: Poster #: CR-075

An 18 month old male presents with fever and green discharge from the right external auditory canal. A temporal bone CT demonstrated an 8mm cylinderical structure 3cm in length isointense to muscle with linear central hypoattenuation. An MRI demonstrated a cylindrical signal void on all sequences performed; including T1, T2, and FLAIR sequences; within the masticator space corresponding to the foreign body on CT, although the dimensions appeared slightly larger. There was considerable surrounding edema with findings consistent with osteomyelitis of the mandible with right mastoid and middle ear effusions. In the operating room a small opening on the buccal mucosa was identified and a 3 cm green crayon fragment was removed. Upon further questioning the mother reports the child running with a green crayon, and tripping approximately 3 weeks prior to presentation. The child was treated with IV antibiotics following foreign body removal and is recovering well.

Given the common understanding of a crayon as a solid stick of parafin wax, the imaging appearance as a foreign body on CT and MRI was unexpected. On CT the overall density was isointense to soft tissues and demonstrated a central linear area of hypoattenuation. The central hypoattenuation corresponds to a central air channel in some crayons by the method of manufacture. On MRI the low signal with apparent blooming is related to the pigments. In modern crayons these pigments are transition metal compounds. Iron oxide complexes are the most important and are responsible for the yellow, orange, red, brown, and black color families and their various permutations and mixtures. Other transition metal compounds such as titanium dioxide for white, and copper for blue are also used. Pigments make up to 10% of a crayon. In our case of a green crayon, the iron oxide particles responsible for the yellow portion of the green would explain the abscence of signal on routine MRI sequences with apparent blooming. Understanding the appearance of crayons can help positively identify them as foreign bodies, and may help identify small retained fragments. Read More

Authors:  Mcallister Aaron , Lall Neil

Keywords:  foreign body, Crayon, MRI, CT, masticator space

Law Emily,  Luo Yu

Final Pr. ID: Poster #: CR-025

Ultrasound is the first line of study of radiolucent foreign bodies, such as wooden or organic foreign bodies. The reported sensitivity is up to 90-100%. However, the orientation, location, and size of such foreign bodies can pose challenges for accurate detection.

Case Presentation: We present a case of a 16-year-old girl who stepped on a small wooden stick, leading to a foreign body penetrating between her fourth and fifth toes, which was removed in the emergency room. Post-removal X-ray and ultrasound failed to identify any residual foreign body, and the patient was discharged home with antibiotics. However, persistent pain and progressive foot swelling prompted a return to the Emergency Room two weeks later. A repeat ultrasound showed increased soft tissue swelling, and hyperemia centered around the webspace of the fourth and fifth digits but failed to detect the foreign body. Subsequent MRI revealed a vertically oriented 1.7 cm long cylindrical structure with a diameter of 0.3cm, demonstrating a hypointense signal in all sequences and hyperintense signal and enhancement in the surrounding tissue compatible with the foreign body. In retrospect, a tiny echogenic focus corresponding to the end of the foreign body is present in a similar location on some of the images of both sonographic exams. The foreign body was surgically removed, and the patient completely recovered within a week.

Discussion: This case highlights the limitations of ultrasound in detecting wooden foreign bodies, particularly when they have a unique orientation, location, and small dimensions; in this case, the foreign body was found vertically oriented (thus perpendicular to the ultrasound probe surface) and between the toes. The ultrasound can only detect the tiny end of the foreign body, which can be easily missed or misinterpreted. With its excellent tissue characterization capabilities, MRI proved to be a valuable tool in this challenging scenario. While ultrasound remains a highly sensitive and specific tool, clinicians should consider additional imaging modalities when faced with challenging cases to avoid missed diagnoses and unnecessary complications. Read More

Authors:  Law Emily , Luo Yu

Keywords:  foreign body, MRI, US

Johansen Andrew,  Lee Jacob,  Robinson Amie,  Chan Sherwin

Final Pr. ID: Poster #: SCI-045

Foreign body (FB) ingestion can be a life threatening event for pediatric patients. The imaging for suspected FB is an esophagram. This procedure requires radiologist involvement, patient cooperation and has a higher dose of radiation than chest digital tomosynthesis (DTS). We want to describe usage of DTS in the pediatric population to aid in detection of radiolucent esophageal FB. Read More

Authors:  Johansen Andrew , Lee Jacob , Robinson Amie , Chan Sherwin

Keywords:  Digital Chest Tomosynthesis, Esophageal Foreign Body, Esophagram

Methratta Sosamma,  Brian James

Final Pr. ID: Poster #: EDU-064

Case based pictorial review of use of CT in identification of foreign bodies in the pediatric aerodigestive tract with plain film/GI comparison/correlation. Review CT technique and radiation dose considerations. Review normal anatomy as it relates to common locations of airway and esophageal foreign bodies with examples. Describe anatomic anomalies that increase risk for retained foreign body with examples. Describe/demonstrate associated imaging findings of complications associated with foreign bodies. Describe how information obtained by CT can direct management of children with foreign body of the aerodigestive tract. Read More

Authors:  Methratta Sosamma , Brian James

Keywords:  Foreign body, CT, aerodigestive

Deaver Pamela,  Masand Prakash

Final Pr. ID: Poster #: CR-048

In a child with escalating hemoptysis, negative TB testing, and history of penetrating thoracic trauma, chronic inflammation and vascular injury as a result of radiolucent foreign body should be considered. Read More

Authors:  Deaver Pamela , Masand Prakash

Keywords:  Foreign Body, Pseudoaneurysm, Tuberculosis