A four-year-old female comes to the unit for a sedated brain MRI. She has a history of seizures. She receives oral midazolam prior to IV placement, and is sedated with propofol without incident. Approximately five minutes into the scan, she has to be removed from the scanner because there was significant artifact showing up on the MRI.
Two specs of glitter were then removed from her hair and her ear was examined with an otoscope. Upon examination of the ear, a significant amount of hard cerumen was visualized. An attempt to remove the cerumen with saline and a curette was unsuccessful. Due to the inability to fully visualize the ear canal, an x-ray was obtained. The x-ray showed a radio-opaque foreign body (likely metal bolt) stuck in the ear canal. After recovering from sedation and an aborted MRI, she was discharged to follow up with ENT. Several days later, after treatment with ear drops to loosen the cerumen, she went to ENT to have the metal bolt removed. She was then sedated at a later date for the MRI.
A 20-month-old male with a complex medical history including early onset inflammatory bowel disease is sedated for a CT scan of his chest and abdomen to look for fungal growth. The scan was negative for fungus, but a 1.2 x 2.4 cm rectangular density within loops of bowel is seen. A plain film was done which verified the presence of an object consistent with a Lego piece. There was no further treatment, as the object was assumed to “pass” on its own.
While we screen for red flags and our technologists screen for metal, there are always “surprises” that come along. We monitor NPO times for “milk, solids, and clear liquids” and request that young patients not brush their teeth, lest they swallow toothpaste while doing so. But situations like the ones described above can happen and continue to amaze us.
As the saying goes, “kids can do the darndest things”.