Artifact - damaged mattress simulating bony fragment

Case contributed by Dr Jörgen Strömberg

Presentation

Within a couple of days, two different patients presented with images suggesting unusual fractures, none of which corresponded with clinical status.

Patient Data

Age: Not applicable

At the plantar aspect of the foot, there appears to be a bony fragment, of unclear origin. This did not match the region of tenderness, and subsequent CT failed to demonstrate any fragment.

At the dorsal aspect of the distal fibula, there is a cortical irregularity suggesting a minor fracture. There were however no corresponding findings on the other projections, and the patient reported no tenderness at this specific location.

Upon inspection of the equipment in the relevant exam room, a minor damage to the mattress of the exam table was revealed.

The size of this damage matched the findings on the exams. In retrospect, both patient images showed a discrete lucency adjacent to the suspected "fragments". This lucency corresponds to the defect in the mattress cover, as the semi-detached flap was folded away.

Case Discussion

These cases demonstrate the need to correlate image findings with clinical presentation. In cases where image findings suggest uncommon or bizarre pathology that do not correspond with the clinical presentation, artifacts may be a possible explanation - especially when this occurs repeatedly in diefferent patients, within a short period of time.

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