Radiological features and management of retained needles

Abstract

The identification of retained needles is essential because of their sharp structure with possible life-threatening complications. However, radiological evaluation could be challenging, especially in case of needles' relatively poor conspicuity and small dimension. This pictorial essay focuses on clinical issues (needle features, retention mechanisms and associated complications) and technical aspects (choice of the best diagnostic modality and technique) that can lead the radiologist to an earlier and proper diagnosis of needle retention in order to provide the best treatment for the patient.

Figure 1.

A 12-year-old child admitted to the emergency department after ingestion of a sewing needle, without clinical symptoms. Frontal and lateral radiographs showed the ingested needle located in the upper gastrointestinal tract, without radiological signs of perforation. After radiological identification, endoscopic examination quickly identified and removed the needle within the stomach lumen.

Figure 2.

A 63-year-old female admitted to the emergency department after ingestion of a sewing needle, without clinical symptoms. Frontal and lateral radiographs (A, B) showed the ingested needle (arrows) located in the upper gastrointestinal tract without radiological signs of perforation or other complication. Before entering the endoscopy room, the patient suddenly complained of upper abdominal pain; an ultrasound examination was performed and demonstrated (C, parasagittal oblique scan) that the needle (arrows) had penetrated through the stomach wall (point of arrow) and got stuck into the segment III of the liver (*). It was then removed in the operating room.

Figure 3.

65-year-old male underwent hip replacement surgery. At the end of the operation, the needle count was incorrect. Because of the mismatch, a frontal radiograph of the left hip was obtained in operating room (A) and showed a curvilinear surgical needle (arrow) near the prosthesis. The surgical cavity was then re-explored and the needle removed. The subsequent radiograph demonstrated no remnants (B).

Figure 4.

A 20-year-old male admitted to the emergency department for atrial fibrillation. Frontal and lateral chest radiographs showed a surgical needle in the subcutaneous tissue along the right lateral wall of the thorax that external physical examination failed to identify. It was concluded that probably the needle was lost during the surgery for pectus excavatum that the patient underwent several years before.

Figure 5.

A 41-year-old female was admitted to the emergency department for upper abdominal pain 15 days after bariatric surgery. An abdominal radiograph (A, B) showed a surgical needle (arrows) in the subdiaphragmatic region. The CT scan (C, D, E) showed the surgical curvilinear needle between the segment II of the liver and the diaphragm.

Figure 6.

A 19-year-old female with type 1 diabetes was admitted to the emergency department with right leg pain after insulin injection. Frontal and lateral radiographs showed in the lateral projection (A), the fragment of a broken insulin needle (arrow) in the anterior portion of right thigh; in the frontal view (B), the broken needle was undetectable because of his orientation (parallel to X-ray beam), thinness and the femoral overlap.

Figure 7.

A 37-year-old drug addict was admitted to the emergency department after the breaking of an injection needle inside the right elbow during an attempt of heroine injection. Frontal and lateral radiographs (A, B) showed a fragment of a broken needle (arrows) in the anterior soft tissues of the elbow.

Figure 8.

A 34-year-old female underwent abdominal surgery for ovarian cancer. During the attempt to suture the inferior vena cava, accidentally injured, the surgical needle was lost. Chest radiograph (A, magnified in B) in the operating room showed the surgical needle (arrow) projectively displayed on the left border of heart and the subsequent CT scan (C, D) identified the needle inside the artery for the posterior segment of the left lower lobe, with no signs of bleeding, pneumothorax, heart injury or infarct. The needle embolized to pulmonary circulation through the tear in the inferior vena cava. In a following CT scan (E, F), the needle migrated and was located in a distal segment of the same vessel. According to both the absence of complications in the CT scan and the clinical stability, no endovascular or surgical attempt to remove the needle was made.

Figure 9.

A 52-year-old seam stress reported metallic foreign bodies in the informed consent for MRI. Radiograph (A) and CT scan (B, C) were performed and identified two straight needles (arrows) in the medial region of the thigh, accidentally penetrated by sewing several years before. They were subsequently removed to perform the MRI.

Figure 10.

A 81-year-old female suffering from depression was taken to the hospital by her family because of lower abdominal pain. Radiographs on frontal (A) and left lateral decubitus views (B) showed a long needle (18 cm) placed in the lower abdomen without radiological signs of perforation. The female confessed that she had tried to commit suicide by sticking an upholstery needle inside her rectum. After removing the needle, a CT scan (C, D) was performed because of increasing of abdominal pain and showed a fluid collection in Douglas pouch (star) with free air inside (arrows).

Figure 11.

A 72-year-old female was admitted to the emergency department with lower abdominal pain after a fall while she was walking with a box of sewing needles in her hands. Radiographs (A) showed a sewing needle projectively on the left iliac crest. The subsequent CT scan (B) demonstrated the needle in the subcutaneous tissue of the anterior abdominal wall.

Figure 12.

Management of needle ingestion and penetration.

Figure 13.

Management of iatrogenic retained needles.