Fractured aluminum nasopharyngeal swab during drive-through testing for COVID-19: radiographic detection of a retained f
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CASE REPORT
Fractured aluminum nasopharyngeal swab during drive-through testing for COVID-19: radiographic detection of a retained foreign body Antoine Azar 1 & Daniel E. Wessell 1 & Jeffrey R. Janus 2 & Leslie V. Simon 3 Received: 23 July 2020 / Revised: 6 August 2020 / Accepted: 9 August 2020 # ISS 2020
Abstract The ongoing coronavirus disease 2019 (COVID-19) pandemic has increased the need for safe and efficient testing as a key containment strategy. Drive-through testing with nasopharyngeal swab has been implemented in many places in the USA as it allows for expeditious testing of large numbers of patients, limits healthcare workers’ risk of exposure, and minimizes the use of personal protective equipment. We present a case where the aluminum shaft of the nasopharyngeal swab fractured during specimen collection at a drive-through testing facility and was suspected to have remained in the asymptomatic patient. Initial evaluation with a series of radiographs covering the skull base, neck, chest, and abdomen did not reveal the swab. On further clinical evaluation, the swab was found endoscopically, lodged between the left inferior turbinate and nasal floor, and was removed by an otorhinolaryngologist. Using a phantom model, we aimed to delineate an imaging technique to better visualize the aluminum shaft of the nasopharyngeal swab on radiographs to help in identification. A technique using lower tube voltage (kVp) with tight collimation centered at the nasal bones area produced the best visualization of the aluminum shaft of the swab. Recognition that aluminum foreign bodies may be difficult to visualize radiographically and optimization of radiograph acquisition technique may help guide clinical management in unusual cases. Further evaluation with computed tomography or endoscopy should be considered in suspected cases where radiographs are negative. Keywords COVID-19 . Nasopharyngeal swab . Radiographs . X-ray . Aluminum . Foreign body
Introduction The USA has performed millions of tests for SAR-CoV-2, the virus that causes COVID-19. Drive-through testing was * Antoine Azar [email protected] Daniel E. Wessell [email protected] Jeffrey R. Janus [email protected] Leslie V. Simon [email protected] 1
Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224, USA
2
Department of Otorhinolaryngology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224, USA
3
Department of Emergency Medicine, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224, USA
first implemented in South Korea [1] but is now used throughout the world to efficiently test large numbers of patients as the cornerstone of successful containment strategies [2]. The entire process takes less than 10 minutes for each patient and can be performed without the patient ever having to leave their car. This allows for minimal usage of personal protective equipment and minimalizes contact time between potentially infectious patients and healthcare workers [3]. Our healthcare organization has perf
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