“Black ring-shaped burn” in button battery ingestion is not a burn — Comparison with charring using spectral CT

Abstract

To compare “black ring-shaped burn” (BRSB) and charring using spectral computed tomography (CT). Spectral CT was performed using chicken pectoralis minor muscle, processed in three ways and unprocessed as a control: a) BRSB generated by bringing the negative pole surface of a 3 V button battery (BB) into contact with the muscle; b) BRSB caused by a 1.5 V BB; c) charring caused by broiling; and d) control. Attenuation values were compared between BRSB and charring. Muscles were formalin-fixed and stained with Perls’ Prussian blue. Attenuation values from polychromatic 120-kVp images were significantly higher for BRSBs than for charring. In the spectral Hounsfield unit curve, attenuation values for BRSBs were higher for lower energy. Histopathologically, BRSBs stained positively with Perls’ Prussian blue. This study using spectral CT revealed that BRSB contains metal and confirmed the presence of Fe³⁺ histopathologically. BRSB differs from charring due to burns. The exact composition of BRSB remains unclear, but this report is the first to show that BRSB differs from charring using spectral CT. Clarification of the composition of BRSB is expected to facilitate the development of more effective BRSB removal therapy.