Radiologists Diagnose and Treat Self-Embedding Disorder in Teens

Wednesday, December 3, 2008 General News
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CHICAGO, Dec. 3 Minimally invasive, image-guided treatment is a safe and precise method for removal of self-inflictedforeign objects from the body, according to the first report on "self-embedding disorder," or self-injury and self-inflicted foreign body insertionin adolescents. The findings will be presented today at the annual meeting ofthe Radiological Society of North America (RSNA).

"Radiologists are in a unique position to be the first to detect self-embedding disorder, make the appropriate diagnosis and mobilize the healthcaresystem for early and effective intervention and treatment," said the study'sprincipal investigator, William E. Shiels II, D.O., chief of the Department ofRadiology at Nationwide Children's Hospital in Columbus, Ohio.

Self-injury, or self-harm, refers to a variety of behaviors in which aperson intentionally inflicts harm to his or her body without suicidal intent.It is a disturbing trend among U.S. adolescents, particularly girls.Prevalence is unknown because many cases go unreported, but recent studieshave reported that 13 to 24 percent of high school students in the U.S. andCanada have practiced deliberate self-injury at least once. More common formsof self-injury include cutting of the skin, burning, bruising, hair pulling,breaking bones or swallowing toxic substances. In cases of self-embeddingdisorder, objects are used to puncture the skin or are embedded into the woundafter cutting.

Dr. Shiels and colleagues studied 19 episodes of self-embedding injury in10 adolescent girls, age 15 to 18. Using ultrasound and/or fluoroscopicguidance, interventional pediatric radiologists removed 52 embedded foreignobjects from nine of the patients. The embedded objects included metalneedles, metal staples, metal paperclips, glass, wood, plastic, graphite(pencil lead), crayon and stone. The objects were embedded during injuries tothe arms, ankles, feet, hands and neck. One patient had self-embedded 11objects, including an unfolded metal paperclip more than six inches in length.

Ultrasound guidance allowed the researchers to detect the presence andlocation of wood, crayons and plastic objects, not detectable on x-rayexaminations. Removal was performed through small incisions in the skin thatleft little or no scarring and was successful in all cases, withoutfragmentation or complications.

"This technique offers surgeons and emergency physicians a safe andeffective alternative for removal of foreign bodies, including objects at riskfor fragmentation during traditional operative techniques," said co-authorAdam Young, B.S. "The small incision minimizes scarring and deformity, whichis key for the self-esteem of this unique, high-risk group of patients."

Co-authors are James Murakami, M.D., Brian Coley, M.D., and Mark Hogan,M.D.

Note: Copies of RSNA 2008 news releases and electronic images will beavailable online at beginning Monday, Dec. 1.

RSNA is an association of more than 42,000 radiologists, radiationoncologists, medical physicists and related scientists committed to excellencein patient care through education and research. The Society is based in OakBrook, Ill. (

Editor's note: The data in these releases may differ from those in theprinted abstract and those actually presented at the meeting, as researcherscontinue to update their data right up until the meeting. To ensure you areusing the most up-to-date information, please call the RSNA Newsroom at1-312-949-3233.

For patient-friendly information on interventional radiology procedures,visit A GLANCE -- Radiologists have begun using a minimally invasive, image-guided technique to detect and remove objects inserted by teens into their arms, hands, feet, ankles and necks. -- This is the first study to report on an emerging condition known as self-embedding disorder. -- Self-embedded objects removed included needles, staples, paper clips, wood, stone, glass, pencil lead and a crayon. -- Self-injury has been reported in 13 to 24 percent of high school students in the U.S. and Canada.

SOURCE Radiological Society of North America (RSNA)

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