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Examination of metal mobilization from a gunshot by scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-Ray spectroscopy, and inductively coupled plasma optical emission spectroscopy: a case report

Bilen, Bukem and Ateş Alkan, Fatma and Barutcu, Ümit Bora and Sezen, Meltem and Ünlü, Mehmet Burçin and Aghahev, Kamran (2018) Examination of metal mobilization from a gunshot by scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-Ray spectroscopy, and inductively coupled plasma optical emission spectroscopy: a case report. Journal of Medical Case Reports, 12 (1). ISSN 1752-1947

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Official URL: http://dx.doi.org/10.1186/s13256-018-1905-7

Abstract

Background: Projectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream. However, the local effect around the metallic object has not been investigated and the main goal of our study is to examine the influence of the object in close proximity of the object. Case presentation: A 36-year-old Caucasian woman with one metallic pellet close to her sciatic nerve due to a previous shotgun injury at the gluteal area presented with a diagnosis of recurrent lumbar disk herniation at L4-5 level. A physical examination confirmed chronic neuropathy and she underwent a two-stage surgery. The surgery included removal of the foreign body, followed by discectomy and fusion at the involved level. During the removal of the metallic foreign body, a tissue sample around the pellet and another tissue sample from a remote area were obtained. The samples were analyzed by scanning acoustic microscopy, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Lead, chromium, copper, cadmium, iron, manganese, selenium, and zinc elements in tissue, blood, and serum specimens were detected by inductively coupled plasma optical emission spectroscopy. Conclusions: An acoustic impedance map of the tissue closer to the metallic body showed higher values indicating further accumulation of elements. Energy-dispersive X-ray spectroscopy results confirmed scanning acoustic microscopy results by measuring a higher concentration of elements closer to the metallic body. Scanning electron microscopy images showed that original structure was not disturbed far away; however, deformation of the structure existed in the tissue closer to the foreign body. Element analysis showed that element levels within blood and serum were more or less within acceptable ranges; on the other hand, element levels within the tissues showed pronounced differences indicating primarily lead intoxication in the proximity of the metallic body. We can state that residues of metallic foreign bodies of gunshot injuries cause chronic metal infiltration to the surrounding tissue and induce significant damage to nearby neural elements; this is supported by the results of scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy.

Item Type:Article
Uncontrolled Keywords:Gunshot injury; Lead toxicity; Metal infiltration; Scanning acoustic microscopy
Subjects:R Medicine > R Medicine (General) > R856-857 Biomedical engineering. Electronics. Instrumentation
R Medicine > R Medicine (General) > R858-859.7 Computer applications to medicine. Medical informatics
Q Science > QC Physics > QC176-176.9 Solids. Solid state physics
T Technology > T Technology (General) > T174.7 Nanotechnology
ID Code:38256
Deposited By:Meltem Sezen
Deposited On:22 Aug 2019 14:53
Last Modified:22 Aug 2019 14:53

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