Teaching Case

Foreign metallic wires in the face discovered on plain films.

The patient was admitted to hospital following a road accident. Clinical examination revealed tenderness along the left trapezius muscle. Her medical history was marked by a long history of depression. No previous history of surgery existed.

Cervical spine radiographs noted a loss of cervical spine lordosis (not shown here) and numerous foreign metallic wires within the face (Fig. 1).

The patient informed us that she was being treated for depression with permanent subcutaneous gold acupunture needles. This method of acupunture originating from China, and is currently used in several Asiatic countries (1). Fine gold needles are introduced through the skin into the subcutaneous tissue or into muscles (2). Permanent gold wire implants may be found anywhere, but the face location is uncommon. Usually these permanent gold needles are inserted in the lumbar paraspinal areas for back pains (3), or in the abdominal wall for digestive system pathologies. Baek et al. (1) reported a case where gold needles were erroneously inserted into the liver, pancreas and kidney without complications.

It is easy to recognise these fine needles on X-ray or on computed tomography studies, but radiologists must be warned of this peculiar type of acupuncture if ultrasonography or magnetic resonance imaging are directly performed, especially when needles have been inserted into the abdominal organs. Acknowledgement: We gratefully thank Paul Michael Walker for his review of the manuscript.