RT Journal
A1 Renz EM, Ling G, Mork KJ, Ecklund JM
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD April 1
VO 147
IS 4
SP 391
OP 392
DO 10.1001/archsurg.2011.872a
UL http://dx.doi.org/10.1001/archsurg.2011.872a
AB 
A 41-year-old man visited the emergency department because of acute onset of a headache as he was walking home after a local soccer match. The patient reported hearing what sounded like gunfire in the distance, but nothing to suggest danger to him or anyone else in the vicinity. While walking, he felt something hit the top of his head. Reaching up, he felt a small solid object barely protruding from his scalp for which he now sought medical care. He denied any change in consciousness, change in vision, nausea, weakness, or any other symptoms; he denied the use of any medications or alcohol. Physical examination revealed a healthy-appearing man in no acute distress with normal vital signs and no neurological deficit. Examination of his scalp near the area of reported pain revealed a small, circular, metallic object beneath his hair, flush with his scalp and surrounded by traces of dried blood (Figure 1).