A Case of Graphite Foreign Body Misdiagnosed: DISCUSSION continue

Lead of a pencil

Almost all foreign bodies according to the wound sites an be demonstrated using radiological methods (native picture, ultrasound examination, xeroradio- graphy, CT, MRI). Stab wound to the spinal cord by a pencil are rare but result in a serious problem such as paraplegia. In spinal penetrating cases, magnetic resonance imaging(MRI) is reported to be useful. MRI can show that the foreign body had passed the spinal cord, causing marked indentation of the cord and dura with air along its track. In evaluating the patient with a presumed intraorbital foreign body, computerized tomography (CT) is the most valuable tool. CT can provide critical information regarding location and composition. There are several reports of unrecognized intraorbital or periorbital foreign bodies diagnosed as graphite pencil fragments by CT. There can be CT findings such as dense linear fragment due to the graphite (graphite is surprisingly dense and may be mistaken for a bone fragment or partial volume averaging of a bone margin), chronic osteomyelitis or benign reactive osteitis adjacent to the dense fragment and soft tissue mass surrounding the dense graphite fragment at its center. In investigating any soft-tissue mass, skin biopsy is most important before embarking on definitive treatment.

A pencil is believed to be a harmless and chemically stable material, but several reports indicate that caution must be exercised when treating stab injuries caused by pencils. All penetrating injuries caused by a pencil should be carefully assessed and treated in order to remove all pieces of lead from the wound.
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The reported graphite granulomas, all presented many years after the injury. In our case, though there was no specific histological changes at the time of biopsy, there is the possibility of change that if left in the tissue for a longer duration. We should be aware that graphite granules embedded in the skin may give rise to clinically alarming delayed reactions. Here we report a case of graphite foreign body misdiagnosed as blue nevus.