When I first tell people outside of the medical profession that I am an emergency radiologist, some variation of the following conversation often occurs:
Them: “So, you’re the one that takes the x-rays of people? My friend/uncle/sister/former roommate is a radiologist too”.
Me: “No, the hard working people who take the x-rays are the radiologic technologists. The radiologists like me are doctors behind the scenes, interpreting the x-rays and getting a report to your primary physician.”
Them: “Oh, so you see all the x-rays? What’s the craziest thing you've ever seen up someone’s butt on an x-ray, or does that even really happen?”
Me: “You’re referring to what we call a foreign body, and I've seen everything you can imagine… trust me, if it’s out there, it’s been in someone.”
Now, as the reader, you may be;
a) questioning the sanity of the people I associate with and shocked by my response.
Or, perhaps you're;
b) pondering the rectal foreign body possibilities, certain that I underestimate the boundaries of your imagination.
Either way, as you go through this book, I'm sure your jaw will drop in disbelief. Of course, there's more to foreign bodies (and this book) than just the xxx-rays.
"Foreign Body" is defined as any object or substance found in an organ or tissue in which it does not belong under normal circumstances.
Foreign bodies can be inserted, ingested, inhaled, or introduced (intentionally or by accident), and therefore can end up nearly anywhere within the body. From the skin surface, their position is often uncertain. However, x-rays can be used to detect a foreign body’s location and decipher the best approach for removal.
This book will focus on interesting x-rays of foreign bodies that brought patients to emergency rooms. Prompt detection is critical to minimizing complications. Therefore, all clinicians should be aware of what various foreign bodies look like on x-rays.
From the perspective of the general public, this book is written without complex medical terminology so that everyone can benefit from it. I’ll show you the x-ray and let you guess what the foreign body is. Occasionally, I provide you with a clue to get started. But, as a picture is worth a thousand words, I’ll often just let the image do the talking! On the next page, I’ll tell you what it was and how it got there. Often why it’s there is as interesting as the image itself. Of course, all patient identifying information has been removed or changed to protect patient privacy and anonymity.
I've broken the x-rays down into 3 major categories.
Category 1: Ingested or Inhaled
The mouth innocuously enough accepts foreign bodies. Unfortunately, there are tight areas within the gastrointestinal tract where these items can get stuck. Furthermore, some objects (such as sharp items or certain types of batteries) can be dangerous or toxic if not retrieved. Inhaled foreign bodies are the ones that end up in the nose or airway, and in my experience, are most often the byproduct of turning your back for 2 seconds while your toddler explores the living room.
Category 2: Introduced
Welcome to the gun and knife show. Whether inadvertently caused by the patient or inflicted by someone else intending harm to the patient, x-rays play an important role in characterizing and localizing introduced foreign bodies. In addition to the medical relevance, these images often end up in forensics, delineating the type and trajectory of the weapon involved. We’ll cover some of the ballistic basics as they pertain to x-rays in this section. The category also includes non-weapon foreign bodies that are introduced into the body, such as from stepping on a nail.
Category 3: Inserted
Last but not least…the XXX-rays. Technically, these foreign bodies can be classified as introduced. However, given the “unique” circumstances under which many of these cases present, they deserve a category of their own. When activities occurring in the privacy of one’s home go wrong, an embarrassing visit to the ER often ensues.