PMC9168336_01
The image shows an iron rod passing through the upper part of the right side of the chest (a), an iron road entering into the neck right side of the neck (b), and coming out of the right high parietal region (c). Bougie-assisted endotracheal intubation (d).
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F1
On local examination, a 3 feet iron rod with a thin coating of rust, approximately 1 cm in diameter, had entered the patient's body by piercing through the skin and subcutaneous tissue of the right upper lateral chest wall just below the right clavicle and came out from the inferior half of the right side of the neck [Figure 1a]. However, iron rod re-entered his body through the right superior half of the neck, just inferior and medial to the angle of the mandible on the right side, passed through the base of the skull, and came out from the posterior surface of the right side of the head 2-3 cm lateral to the midline [Figures 1b and c]. As the rod was anchored to the chest wall and the head, his neck was transfixed in flexion and tilted toward the right side making intubation difficult [Figure 1d]. After doing so, we got the little lateral movement of the neck and we could negotiate laryngoscope and could intubate over the boogie [Figure 1d].
X-ray skull lateral view (a) and right oblique view (b) show metallic objects traveling through the skull. CT scan brain plain study shows a metallic artifact extending from the skull base to the high parietal region on the right side (c).
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F2
He underwent an X-ray skull that revealed a metal rod in the skull [Figures 2a and b]. A few hemorrhagic spots were noticed along the tract created by the rod [Figure 2c and Figures 3a, b].
CT scan head (bone window) showing metallic iron rod in behind right petrous bone (a) and a sagittal view showing its passage through tentorium (b). CT angiography of the neck showing intact left and right carotid artery and left internal jugular vein with the absence of the right jugular vein (c and d).
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F3
A few hemorrhagic spots were noticed along the tract created by the rod [Figure 2c and Figures 3a, b]. However, on the CT venogram, the right sigmoid sinus, right jugular bulb, and right internal jugular vein were not visualized [Figures 3c and d].
The clinical photograph showing craniectomy around the exit point of an iron rod from the skull (a), explored wound around the entry point of iron rod in the neck (b), about 2.5 feet iron rod removed from the skull (c).
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F4
The dura mater opened around the rod [Figure 4a]. The general surgical team made a horizontal incision in the neck at the entry site and the wound was explored [Figure 4b]. However, the rod was safely removed [Figure 4c].
CT scan brain immediately after surgery (a) and after 4 days (b) showing hyperdense lesion along the infratentorial course of iron rod with the presence of subarachnoid hemorrhage suggestive of residual hematoma.
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F5
Bone fragments were also seen in the right jugular foramen [Figure 5a]. On the 4th postoperative day, he underwent a CT scan brain plain study [Figure 5b], no new changes observed.
The patient after surgery.
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F6
The patient was fully conscious and well-oriented to time, place, and person [Figure 6].
Furthermore, a small fragment of bone was noticed traversed along with the iron rod just below the tent and the right parietal craniectomy defect. CT scan brain on the 10th postoperative day showing temporal resolution of hematoma along the course of an iron rod (a) and on the 21st postoperative day showing new hypodensity in the region of the right ganglion capsular region and right parieto-occipital region suggestive of recent infarct in the right posterior cerebral artery territory (b).
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F7
His repeated CT scan brain plain study on the 10th day showed resolving changes [Figure 7a]. His brain CT scan revealed hypodensity in the deep right posterior cerebellar artery territory [Figure 7b].