Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA.
Department of Otorhinolaryngology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA.
Skeletal Radiol. 2020 Nov;49(11):1873-1877. doi: 10.1007/s00256-020-03582-x. Epub 2020 Aug 21.
The ongoing coronavirus disease 2019 (COVID-19) pandemic has increased the need for safe and efficient testing as a key containment strategy. Drive-through testing with nasopharyngeal swab has been implemented in many places in the USA as it allows for expeditious testing of large numbers of patients, limits healthcare workers' risk of exposure, and minimizes the use of personal protective equipment. We present a case where the aluminum shaft of the nasopharyngeal swab fractured during specimen collection at a drive-through testing facility and was suspected to have remained in the asymptomatic patient. Initial evaluation with a series of radiographs covering the skull base, neck, chest, and abdomen did not reveal the swab. On further clinical evaluation, the swab was found endoscopically, lodged between the left inferior turbinate and nasal floor, and was removed by an otorhinolaryngologist. Using a phantom model, we aimed to delineate an imaging technique to better visualize the aluminum shaft of the nasopharyngeal swab on radiographs to help in identification. A technique using lower tube voltage (kVp) with tight collimation centered at the nasal bones area produced the best visualization of the aluminum shaft of the swab. Recognition that aluminum foreign bodies may be difficult to visualize radiographically and optimization of radiograph acquisition technique may help guide clinical management in unusual cases. Further evaluation with computed tomography or endoscopy should be considered in suspected cases where radiographs are negative.
当前正在持续的 2019 年冠状病毒病（COVID-19）大流行增加了安全有效检测的需求，这是一种关键的控制策略。在美国的许多地方都实施了经鼻拭子的驾车通过检测，因为它可以快速检测大量患者，限制医护人员暴露的风险，并最大限度地减少个人防护设备的使用。我们介绍了一个案例，在一个驾车通过检测点进行样本采集时，鼻咽拭子的铝杆断裂，疑似残留在无症状患者体内。初步评估使用了一系列涵盖颅底、颈部、胸部和腹部的射线照片，但未发现拭子。进一步的临床评估发现，拭子在内窥镜下位于左侧下鼻甲和鼻底之间，耳鼻喉科医生将其取出。我们使用一个体模模型，旨在描述一种成像技术，以便在射线照片上更好地显示鼻咽拭子的铝杆，以帮助识别。一种使用较低管电压（kVp）并紧密准直集中在鼻骨区域的技术可最佳地显示拭子的铝杆。认识到铝制异物可能难以在射线照片上显影，并优化射线照片采集技术，可以帮助指导在罕见情况下的临床管理。对于射线照片为阴性的疑似病例，应考虑进一步进行计算机断层扫描或内窥镜检查。
