Recurring theme

In keeping with the recent theme of this blog, here is another case I saw today.

A 44-year old man who had been in a motor vehicle accident in which he suffered severe brain damage - with consequent developmental delay - came in after being "found down" in the street. The medical record provides an understated description of what I am sure was an impressively squalid appearance:

"A 44-year-old gentleman who came in after being found on the street... Patient fidgety and agitated... [patient] states he was trying to get home and 'decided to crawl'... Patient stated he wanted the police to give him a ride home. He was somewhat confused and disheveled... Drinks alcohol on occasion. Has a history of IV drug abuse... In general, he is a somewhat disheveled gentleman covered with dirt [who is] not wearing any socks or shirt on a rainy day."

He complained of pain that worsened when he stood up. Urine testing showed that he had a raging urinary tract infection.

We got X-rays of his pelvis, which showed the following from the front:



from the side with the patient on his side:



and from the side with the patient on his back:



There are a few interesting things to note from this exam:
1. 4 round bright white things in the middle of the pelvis on the frontal view that change position on the view with the patient on his side and move to the back of the pelvis in the side view taken with the patient on his back. This suggests that those 4 round things are inside the bladder, and are rolling to whatever part of the bladder is closest to the center of the earth.
2. A large gray round thing in the pelvis that probably represents a large fluid-filled bladder.
3. Multiple round bright white things that project in the place where we would expect to find the urethra.
4. Plates and screws in the bones of the pelvis - mementos of the patient's previous auto accident.

Seeing all these things, I let the ER know that this guy had metallic foreign bodies in his urethra that are obstructing his bladder. Some of the metallic foreign bodies are actually inside his bladder.

On further questioning, it turns out that this guy had, for reasons that are unclear, put magnets up his urethra.

I guess he was bored, and didn't have a pencil.

Urology was called, and they tried to remove the metallic foreign bodies in the ER, though according to the medical record, they "[had] some difficulty." They took the patient to the operating room for definitive treatment with an endoscope.

And, for the record, this is the same guy who dropped all the eggnog in my last post.