Presentation
This patient underwent an elective thyroidectomy. Post-operative swab count suggested one missing swab. An intraoperative screening fluoroscopic study performed at the time was unable to visualize the swab and therefore a plain radiograph of the neck was performed.
Patient Data
The coiled/bunched linear metallic density lying to the right of the midline at the C5/6 level represents a retained surgical swab.
Also note the percutaneous thyroidectomy drain.
Case Discussion
X-ray imaging to identify a retained surgical swab is indicated when the post-operative 'swab-count' suggests a discrepancy between the number of swabs used during the operation and the number present at the final count.
Surgical swabs have a thin length of radiodense material running along one edge. It is important that clinicians and radiologists reviewing such films are aware of the appearance of a retained swab - as they are often packed into surgical sites, the metallic strip typically adopts a scrunched/bunched appearance rather than the straight linear density one might otherwise have expected.