Presentation
The patient presents with a nonproductive cough and fever. Incidental finding.
Patient Data
Good inspiration. Normal cardiomediastinal contour.
There are incidental artifacts: a small beaded necklace and a larger necklace with rimmed opacities.
A zoomed image of the teething beads overlying the left shoulder and left apical thorax.
Well-identified lamellated appearance of the traditional teething beads and the smaller beaded necklace.
An x-ray of the teething beads confirms the lamellated appearance. The beads are of uniform size and appearance and mimic "teeth".
Photographs of the teething beads show their grey to pearly white colour and oval shape. I have purposely wound it tight, as sometimes encountered which makes it impossible to remove easily and defeats the purpose of acting as a teething bead or soother!
Case Discussion
Jewellery artifacts are fairly common and often encountered on X-rays and CT examinations especially when performed in immobilised patients with polytrauma. When possible they should be removed to prevent diagnostic confusion and allow optimal assessment of imaging studies.
In this instance, the smaller beaded necklace is tightly wound around the neck and impossible to remove without cutting the necklace.
The larger necklace with an unusual lamellated radiographic appearance is very similar in appearance to "unerupted primary or deciduous teeth". This is a necklace made out of Imfibinga or Ubuchwabasi seeds, derived from a tall grain-bearing perennial tropical grass. They are also known as Zulu teething beads in South Africa. In the rest of the world, they are known as "Job's tears" (Coix lacryma-jobi) or "River Stones" 1. The hard-shelled seeds are naturally bored with holes and do not need to be artificially punctured. They are therefore perfect to use as beads for making necklaces, prayer beads, rosaries, and other ornamental or decorative items 1. They are smooth and cool to the touch and have been used by Zulu women to soothe teething babies for many generations.
It is a coincidence that the radiographic appearance of the seeds somewhat resembles unerupted deciduous teeth!