PMC7793763_01
Pictures and diagnostic images in case 1. A small hole was found in the soft palate in the oral cavity. (A). Lateral craniocervical radiography in case 1 (B). A linear radiolucent area (arrowhead) was found in soft tissues dorsal to the atlantooccipital joint. A sagittal section of the craniocervical T2-weighted image (C). A hypodense linear object penetrated the spinal cord. The sagittal section on craniocervical CT imaging with the soft-tissue setting (WL: 40, WW: 350) (D) and bone window setting (WL: 50, WW: 2000) (E). A linear low-attenuation area penetrated the vertebral canal. The chopstick fragment was more clearly differentiated from air with the bone window setting than with the soft-tissue window setting (C,D). The fragment of the chopstick was removed from the oral cavity. The fragment was consistent with the lost part of the broken chopstick (F).
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F1
On physical examination, a small hole was found at the soft palate in the oral cavity (Figure 1A). Radiography of the craniocervical region revealed a radiolucent area in the dorsal soft tissue of the atlantooccipital joint (Figure 1B). The density of the structure was similar to that of air with the soft-tissue window setting (window level: 50 HU, window width: 350 HU); however, the structure was distinguished easier from air with the bone window setting (window level: 400 HU, window width: 4,000 HU) than with the soft-tissue window setting (Figures 1D,E). T2-weighted images (TE: 125 ms, TR:3,900 ms) (Figure 1C). The imaging findings and clinical history suggested medullocervical penetrating injury by a chopstick, and that the tip of the chopstick remained inside the wound. After death, the tip of the chopstick (3.5 cm length) was found and removed from the hole of the soft palate (Figure 1F).
PMC7793763_02
Pictures and diagnostic images in case 2. At presentation, a decreased level of consciousness, tetraparesis (A), and Horner's syndrome (B) were observed. A low-attenuation linear structure from the oral cavity passing through the atlantooccipital space was found on CT examination (C). The fragment of the chopstick was removed surgically (D).
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F2
At presentation, the mental status of the cat was obtundation and the cat was unable to stand (Figure 2A). Neurological examination revealed non-ambulatory tetraparesis, left miosis and ptosis, and protrusion of the third eyelid suggesting Horner's syndrome (Figure 2B). The wooden foreign body was distinguished from air easier with the bone window setting (Figure 2C). The fragment was consistent with the lost part of the chopstick (Figure 2D).
PMC7793763_03
Picture and MR image in case 3. At the time of referral, the cat exhibited tetraparesis (A). A hyper-intense lesion in the spinal cord parenchyma was identified at the level of C1 on T2-weighted sagittal images (B).
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F3
The proprioceptions of the four limbs were reduced and the spinal reflexes of the four limbs were increased (Figure 3A). MRI revealed a hyper-intense lesion in the spinal cord parenchyma at the level of C1 on T2-weighted images (Figure 3B).