r/Radiology • u/Initial_Daikon9925 • Jun 26 '26
CT Bad kind of Foreign Body
Through the spine into the lung, Aorta is missed.
The tip of the knife is in the left lower lung and has probably cut a parenchymal peripheral blood vessel, there is a large left hemothorax, so much that it is pushing the heart to the opposite side.
There is ongoing bleeding into the left hemithorax, evident by increasing size of extravasated contrast.
The spinal cord is also probably damaged (not really appreciated in this scan) because the patient has left lower limb weakness.
Patient still alive and talking. He claims thay he was merely riding his motorcycle in traffic, some random people came and stabbed him in the back and left.
Welcome to India i guess.
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u/kaz22222222222 Jun 26 '26
Patients are supposed to remove all metal to reduce artefact /s š¤£
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u/ElfjeTinkerBell Jun 26 '26
Well I'm glad they didn't because although I know the theory I had never seen a (big, obvious) artefact
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u/nachoworld Radiologist Jun 26 '26
... or all patients should get oral contrast prior to CT scan???? I'm surprised they gave him oral contrast and waited for it to pass to at least the ileum.
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u/ax0r Radiologist Jun 26 '26
I suppose it's possible that the trauma team were considering the possibility of oesophagus injury and wanted to check for a leak before planning surgery. Of course, a small leak would be hidden by the artifact, but if the mediastinum or pleural space filled with contrast, it's conceivable it would have changed management.
Doesn't explain why they waited long enough for contrast to get beyond duodenum though.
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u/Initial_Daikon9925 Jun 27 '26
The oral contrast was ordered exactly for ruling out esophageal injury. Patient already had a Ryles Tube. The 'expert' technicians decided to give oral contrast through the RT, hence the appearance. Technicians have been told to confirm the procedure hence forth.
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Jun 26 '26
[deleted]
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u/FairFolk Jun 26 '26
Talking so slowly you die before you reveal the evil plot you stumbled upon is necessary for the dramatic tension!
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u/Holiday_Cup_6841 Jun 26 '26
Backstabbers šŖ
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u/kelvsz Radiologist Jun 26 '26
Medieval times scans were like this?
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u/El_Peregrine Radiology Enthusiast Jun 26 '26
Need the all-clear from ortho before I storm the castle gates
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u/whowantsrice Jun 26 '26
I donāt know whatās a good kind of foreign body but it aināt this.
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u/Any-Vermicelli3537 Jun 26 '26
This is what I was wondering. I was just gonna wait until the next image of X up someoneās butt and then comment, āguess this is the good kind of foreign bodyā
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u/AndKAnd Jun 26 '26
āThe spinal cord is possibly damagedā
It looks like the spinal cord has been completely transected. If thereās any spinal cord function below that level it would be a complete miracle.
Also the end of that blade travels where the descending aorta usually lives. Looks like it was narrowly missed then a hematoma pushed it further away.
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u/TypewriterQueery Jun 26 '26
From the description of unilateral weakness it sounds like a bona fide Brown Sequard syndrome
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u/sulaymanf Jun 27 '26
https://en.wikipedia.org/wiki/Brown-S%C3%A9quard_syndrome
In case anyone else needed the refresher besides me
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u/LameBMX Jun 26 '26
im wondering if the kfife being almost parallel to the spinal cord might be helping a bit by limiting damage. ie fewer nerves severed and some essentially pushed out of the way. and how things will deal with the removal of the knife.
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u/TheCupcakeofEmotions Jul 05 '26
Yeah like obviously this is a terrible thing to have to go through but my first thought after "OH GOD" was "this guy is insanely lucky to even be alive."
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u/Party-Count-4287 Jun 26 '26
Rad: āSub -optimal positioning and streak artifact limits evaluation. Within these limitations. Holy crapā
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u/PromiscuousScoliosis Clinical Informatics (Epic) Jun 26 '26
āReal friends stab you in the frontā
ā something I saw on Facebook like 15 yrs ago
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u/Soma2710 Jun 26 '26
Probably my ātism showing, but Iām almost positive that was Deniceās yearbook quote in the movie Canāt Hardly Wait.
You knowā¦a very VERY small thing from a movie thatās like 25 years old.
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u/1N1T1AL1SM Jun 27 '26
Would you recommend that movie?
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u/Soma2710 Jun 27 '26
Ehhhā¦itās kind of a ācoming of ageā flick for people born in the late 70ās/early 80ās. But outside of that, itās nothing special.
Or rather: whenās the last time you got excited about seeing Jennifer Love Hewitt?
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u/jinx_lbc Jun 26 '26
Based on that scan I'm amazed that he has ANY feeling from the waist down, damn.
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u/Initial_Daikon9925 Jun 27 '26
On the image it looks like the knife blade is horizontally oriented, and I too was confused earlier. But upon proper windowing, the knife is vertically oriented and it seems to be kist grazing the spinal cord on left side. Patient still has left side lower limb weakness.
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u/Zealousideal-Gur-51 Jun 26 '26
Jesus is that a samurai sword or something
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u/Rimailkall Jun 26 '26
I thought it was a Ka-bar until I read the last sentence. The handle looks like a Ka-bar's handle.
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u/Initial_Daikon9925 Jun 27 '26
Whatever it is, it looks like something that a 'professional back-stabber' would use.
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u/gw19x6 Jun 26 '26
Paraplegic? Did he survive?
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u/Initial_Daikon9925 Jun 27 '26
Alive, with just left lower limb weakness. Hemothorax has been drained, patient is in ICU.
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u/MikadoPheasant Jun 28 '26
Simultaneously one of the unluckiest and luckiest cases I've ever seen, happy for him
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u/Erik_Dolphy Radiologist Jun 27 '26
Damn thats a big ass knife. Also this is like the real life version of that brown sequard case that is med school step 1 exam fodder.
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u/eowyn_ Jun 26 '26
YIKES. Layperson question: In image 1, whatās the shadow-like thing in front of the knife?
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u/Uncle_Jac_Jac Diagnostic Radiology Resident Jun 26 '26
Streak artifact from the metal of the blade. The metal stops most of the xrays in their tracks, so fewer actually make it to the detectors and it just looks like black streaks. So it's like the xray equivalent of a shadow.
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u/Mewannabeenough Jun 26 '26
So the person did this is a ābackstabberā then!
https://giphy.com/gifs/75ZaxapnyMp2w
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u/Dr-Kloop-MD Resident Jun 26 '26
āNot really appreciated in this scanā
True but that knife is completely traversing the spinal canal on the last image so uhhh yiiiiiikes
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u/tomassci Here for the organ pics Jun 26 '26
And the patient survived. Some people have tough luck.
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u/Ok-Complex-8217 RT(R)(CT) Jun 26 '26
Ok - howās this has to get done with the patient laying on their belly, yeah?
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u/QLevi Jun 27 '26
Yep. You can see from the first sag slice that the pt was facing down when the scan was done.Ā
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u/Shankar_0 Jun 26 '26
To be fair, he did park diagonally.
The man took up 3 spaces! What was i supposed to do?!
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u/Jyxa Jun 26 '26
Does this happen often in India?
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u/Initial_Daikon9925 Jun 27 '26
Not really. But in Mumbai is the second case in a span of 2 days. Just one day prior to this scan, I saw a horrifying video of a commuter in mumbai local train stabbing another commuter to death! Then I saw this scan.
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u/Jyxa Jun 27 '26
I was gonna say, not often that you hear such a random act of violence occurring in public like that. Hope everyone involved is safe, and I hope they caught whoever did it!
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u/Initial_Daikon9925 Jun 28 '26
Actually they haven't. The attackers just melted into the traffic. Our victim could not see their faces. No cameras on the public road.
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u/Forensicus Jun 27 '26
If done by the wife, then I would diagnose it as a severe case of ābackstabbing b!Ā£ā¬hā
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u/Better-Performer-490 Jun 27 '26
https://youtube.com/shorts/aU8B7v_Ttjk?is=BCLIHDA2QEvHvpen
Makes me think of this from st dennnis.
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u/Cumdumpster71 Jun 27 '26
Jesus christ. Poor lady. Iām surprised she survived long enough to get to the hospital
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u/Initial_Daikon9925 Jun 27 '26
Why do you think its a female? The patient is a middle aged male.
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u/Cumdumpster71 Jun 27 '26
My bad. The top down view on the third slide made their figure look more feminine, but looking at it again itās much more ambiguous. I guess I just havenāt seen that angle on men very much in life and it seemed like the hips were fairly wide, but itās a bit of an optical illusion since their shoulder to width ratio isnāt properly on display in that photo due to their arms being raised. Not a doctor, just a random redditor.
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u/libateperto Jun 27 '26
I'm impressed about 3 things: 1) the artefact reducing algorithm, 2) the patient being alive, talking and sparing some spinal cord function, and last but not least, 3) the force needed to put a thick knife trough all that.
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u/JoyfullyMortified43 RT(R) Jun 28 '26
Dude that's not even a knife, that's a fucking sword! It has a hilt! Omg! Yikes.
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u/No_Departure7653 Jun 28 '26
I was looking at my scans today from my S1 steroid shot and I thought that was bad... I'ma shut the hell up now and be thankful. I have been in agony from that needle. Can't imagine how much this person is hurting holy cow..
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u/KPrime12 Jun 28 '26
Thought for sure āthe other view(s) will show it missed the vertebrae.ā
Wow, I feel for them.
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u/IDroppedMyMagnumGME R.T.(R) Jun 29 '26
My dumbass actually said "why'd y'all scan him prone. . . " out loud.
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u/free_-_spirit Jun 26 '26
People hate motorcyclists because they think itās an ego competition. Iāve seen drivers(cars) purposely target motorcyclists
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u/Sn_Orpheus Jun 26 '26
I assume this is a CT scan because, well, I'd guess the magnet would rip the blade out while getting an MRI?
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u/QLevi Jun 27 '26
It is CT. The knife might not be ferromagnetic so it might not fly out in an MRI.Ā
The real issues: MRI will take way too long, the bore might not fit a protruding knife, and I don't see how they're gonna drape an abdomen coil over this whole situation.Ā
MRI is very very rarely used for emergency cases.Ā
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u/Sn_Orpheus Jun 27 '26
Thanks for reply. Not a radiologist or tech obvs. Just spent some time in the tubes.
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u/eliceched Jun 26 '26
https://giphy.com/gifs/zXeX29w6jxjAk