SAEM Clinical Image Series: An Incidental Finding

nail gun

A middle-aged man presented after a motor vehicle collision with a logging truck at 55 miles per hour with low back pain. A computed tomography scan (CT) of the abdomen and pelvis at an outside facility showed a burst fracture of the third lumbar vertebra (L3). The patient had no other complaints. Given the fracture, additional CT imaging was done and the above finding was discovered.

After the incidental finding was found, the patient reported a nail gun accident three years prior where he thought it had just recoiled and struck him in the lip and nose, causing a lip laceration and a minor bloody nose. The patient was seen in the emergency department. The laceration was repaired, and he was discharged without imaging. The patient denied any significant residual symptoms or personality changes. The patient had no idea that a nail had discharged from the gun and lodged in his face and brain.

nail gun

A middle-aged man presented after a motor vehicle collision with a logging truck at 55 miles per hour with low back pain. A computed tomography scan (CT) of the abdomen and pelvis at an outside facility showed a burst fracture of the third lumbar vertebra (L3). The patient had no other complaints. Given the fracture, additional CT imaging was done and the above finding was discovered.

After the incidental finding was found, the patient reported a nail gun accident three years prior where he thought it had just recoiled and struck him in the lip and nose, causing a lip laceration and a minor bloody nose. The patient was seen in the emergency department. The laceration was repaired, and he was discharged without imaging. The patient denied any significant residual symptoms or personality changes. The patient had no idea that a nail had discharged from the gun and lodged in his face and brain.


Vitals: Normal

General: Well appearing

Musculoskeletal: Tenderness over the lumbar spine, mild sternum tenderness

The remainder of the exam was unremarkable.

Neurosurgery and ENT Consult

Given the new finding of a foreign body implanted in the face and brain, a consult to surgical specialists is warranted regarding management. Both Neurosurgery and ENTservices agreed that the risk of removal was greater than leaving the nail in place.

Take-Home Points

  • Nail guns are powerful tools, and injuries from them should be thoroughly evaluated with a low threshold for imaging.
  1. Maghsoudi M, Shahbazzadegan B, Pezeshki A. Asymptomatic Intracranial Foreign Body: An Incidental Finding on Radiography. Trauma Mon. 2016;21(2):e22206. Published 2016 May 1. doi:10.5812/traumamon.22206. PMID: 27626006
  2. Deveer M, Imamoglu F, Imamoglu C, et al An incidental case of asymptomatic intracranial foreign body on CT
  3. Hull KL, Denton-Beaumont R An unsuspected intracranial foreign body on the acute medical unit
  4. Chunhua Q, Qun W. A late-onset seizure due to a retained intracranial foreign body–pencil lead: a case report and review. J Craniofac Surg. 2014;25(2):e109-10. doi: 10.1097/SCS.0000000000000439. PMID: 24621748

Author information

Lincoln Ropp, DO

Lincoln Ropp, DO

EM Resident
OHSU

The post SAEM Clinical Image Series: An Incidental Finding appeared first on ALiEM.

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