Hidden Depths

The radiograph on this issue’s front cover demonstrates a normal image of the abdomen. It is a favourite of mine and one that I use routinely in teaching undergraduate medical students. Take a good look. You may notice a curvilinear gas density projected within the pelvis. See it? This is what a tampon looks like (figure 1). It’s a subtle finding, but once seen, the radiographic configuration is not forgotten. Once the tutorial group moves beyond the potentially salacious, ‘Carry On Doctor’ nature of the subject matter, I like to pose this question. A 24 year old lady is admitted to your hospital with a head injury. On the third day following admission, her clinical state rapidly deteriorates. Can you see anything on the radiograph that might be the cause? Clearly there might be many reasons for this deterioration, including an infection at the body piercing’s skin site (also present on the radiograph) but if anyone had recognised the retained tampon then Toxic Shock Syndrome might enter the differential diagnosis. The point is: unless one looks, one never knows. Intimate examinations are, of course, problematic. Is there reluctance to perform one? Possibly. Is there an assumption that perhaps a nursing colleague has? Maybe.