title: Vertebral body granuloma of the cervical region after pencil injury.
abstract: OBJECTIVE
  Granuloma formation has been reported as a rare complication of pencil lead injury. Insufficient data exist regarding pencil lead injuries of the cervical spine. We present the findings in an 18-year-old male patient with secondary granuloma formation after a penetrating transoral pencil injury. We suggest that imaging characteristics and a detailed history will assist with the diagnosis of such lesions.
  
  
  METHODS
  The patient was an 18-year-old man who presented with cervical pain. His history included falling as a child while having a pencil in his mouth. T2-weighted imaging studies documented a 1- x 1-cm enhancing lesion posterior to the vertebral body at the C3 level. The patient underwent a C3 vertebrectomy, and specimens were notable for infection, pencil lead, and granuloma formation.
  
  
  CONCLUSIONS
  In the evaluation of a potential granuloma or mass lesion of the cervical spine in a child or adolescent, the differential diagnosis may include a neoplasm. Although computed tomography is an ideal tool to detect foreign objects, including pencil leads, only awareness of the potential for pencil lead injuries and that pencil lead fragments may remain unrecognized on computed tomographic scans will assist the physician in diagnosing such injuries.
authors.affiliation: Division of Neurosurgery, Children's Hospital of San Diego, and Division of Neurological Surgery, University of California, San Diego School of Medicine, USA.
authors.forename: Hal S
authors.initials: HS
authors.lastname: Meltzer
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Kim
authors.forename: Burak M
authors.initials: BM
authors.lastname: Ozgur
authors.forename: Michael L
authors.initials: ML
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000293:injuries*; D015745:Granuloma, Foreign-Body / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007854:Lead / Q000009:adverse effects*; D008297:Male
chemical_list: D007854:Lead