Examination of metal mobilization from a gunshot by scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy: a case report

Abstract

BackgroundProjectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream. However, the local effect around the metallic object has not been investigated and the main goal of our study is to examine the influence of the object in close proximity of the object.Case presentationA 36-year-old Caucasian woman with one metallic pellet close to her sciatic nerve due to a previous shotgun injury at the gluteal area presented with a diagnosis of recurrent lumbar disk herniation at L4–5 level. A physical examination confirmed chronic neuropathy and she underwent a two-stage surgery. The surgery included removal of the foreign body, followed by discectomy and fusion at the involved level. During the removal of the metallic foreign body, a tissue sample around the pellet and another tissue sample from a remote area were obtained. The samples were analyzed by scanning acoustic microscopy, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Lead, chromium, copper, cadmium, iron, manganese, selenium, and zinc elements in tissue, blood, and serum specimens were detected by inductively coupled plasma optical emission spectroscopy.ConclusionsAn acoustic impedance map of the tissue closer to the metallic body showed higher values indicating further accumulation of elements. Energy-dispersive X-ray spectroscopy results confirmed scanning acoustic microscopy results by measuring a higher concentration of elements closer to the metallic body. Scanning electron microscopy images showed that original structure was not disturbed far away; however, deformation of the structure existed in the tissue closer to the foreign body. Element analysis showed that element levels within blood and serum were more or less within acceptable ranges; on the other hand, element levels within the tissues showed pronounced differences indicating primarily lead intoxication in the proximity of the metallic body. We can state that residues of metallic foreign bodies of gunshot injuries cause chronic metal infiltration to the surrounding tissue and induce significant damage to nearby neural elements; this is supported by the results of scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy.

A Potentially Dangerous Industrial Projectile Lodged in the Leg of a Steel Factory Worker

“…Additionally, projectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream [16]. Usually, metallic objects embedded into the soft tissue become encapsulated and do not release metals into the systemic circulation.…”

“…Missiles close to the bone, [17], joints, and intervertebral disks are continuously bathed with synovial fluid, which eventually washes off lead from the bullets resulting in systemic toxicity [18,19]. Females are more vulnerable to this form of toxicity which can then lead to neuropathy [16,20].…”

A perspective on persistent toxicants in veterans and amyotrophic lateral sclerosis: identifying exposures determining higher ALS risk

“…Embedded shrapnel from explosive devices and retained bullet fragments also can increase serum levels of toxic metals including Se [167]. Higher risk of ALS was found in naturally seleniferous US regions [168,169].…”

Use of scanning electron microscopy and energy dispersive X‐ray for urine analysis: A preliminary investigation

“…Furthermore, the energy dispersive X‐ray (EDX) coupled with SEM makes it possible to quantify the elemental composition of the observed specimen (Barba et al, 2015; Fernandez‐Segura & Warley, 2008; Scimeca et al, 2017, 2018; Scimeca, Giannini, et al, 2014; Scimeca, Orlandi, et al, 2014). The combination of SEM and EDX techniques results in a powerful tool which is used in various fields (Goldstein et al, 2017), including medical diagnostics (Bilen et al, 2018, 2019; Roman et al, 2019). However, SEM–EDX analysis of urine sediment samples has not yet been explored in clinical laboratory practice.…”