Presentation
Playing alone and later found to have a pencil stuck in the right eye.
Patient Data
A foreign body (pencil) is seen traversing the right superior orbit through the roof of the right orbit into the right frontal lobe with the tip abutting the frontal horn of the right lateral ventricle near the septum pellucidum. Mild acute blood is seen along the tract.
No intraventricular bleed. Associated right periorbital and extraconal hematoma. No blood is seen within the right globe. The remaining brain parenchyma is preserved.
Case Discussion
In this case, the brain parenchyma was penetrated via the orbital roof. The wood of the pencil appears similar density to air on brain windows; however, the pencil lead (graphite) is easily visualized as it appears hyperdense.
Penetrating brain injuries may be low-velocity (involving various objects) or high-velocity (usually due to gunshot). In the pediatric age group, the thin orbital walls can be easily fractured and penetrated by a low-velocity foreign body, which may sometimes be occult and only discovered on imaging1-2.
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