Kinder Surprise? Not to a Radiologist!

What happens when a radiologist decides to investigate the contents of an Easter egg with some of the coolest technology the NHS has to offer?!

 

Kinder egg x-ray hybrid photo

 

A tenth of our chocolate is devoured during the Easter weekend and the average Briton gobbles nine Easter eggs a year.  As diagnostic experts, the average British radiologist is naturally curious to know what lies inside...

Can you flex your diagnostic muscles and piece the toy together from the scans below?

 

Presentation:

A 2 month old egg presented to the emergency department GCS 3.  Initial clinical examination revealed the egg to be a Kinder Surprise.

 

Kinder egg

 

As with most eggs, NICE guidelines* recommend plain radiographs as the initial first line investigation:

*May not be true

 

Kinder egg x-ray prone
Kinder egg x-ray supine
Kinder egg x-ray erect

 

The three radiographs confirmed a Kinder egg containing a toy.  Unfortunatly the blood tests and urine samples were inconclusive, and due to a lack of collateral history, the referring clinician requested further imaging.

The egg failed the MRI safety questionnaire due to the foil wrapper, therefore we decided to perform a CT scan...

 

Kinder egg CT slices

 

Axial, coronal and sagittal CT images demonstrate an egg containing a plastic container with multiple irregularly shaped objects within.  The top right image shows a 3D reconstruction of the outside of the egg, confirming it was chocolate.

 

Kinder egg CT 3D reconstruction 1

 

The above two images are maximum intensity projection (MIP) reconstructions.  They did not add much to the diagnostic process.

We decided to do some 3D surface reconstructions to get a better idea of what was inside...

 

Kinder egg CT 3D reconstruction chopped

 

Partial 3D cutaway reveals the different layers within the Kinder egg including the outer chocolate layer, inner plastic container and objects within.  To further appreciate the toy, the outer layers were digitally sculpted away as shown below.

 

Kinder egg CT 3D reconstruction 2

 

So to all radiologists and non-radiologists out there... have you figured out what the toy is yet?

Read on to find out...

 

The egg underwent an immediate diagnostic shellotomy.  Please see peri-operative photographs below:

 

Opening the Kinder egg

 

Inside the egg was a small container and 5 plastic parts.  These were the parts seen on the CT 3D reconstructions.

 

Kinder egg toy

 

This is what it looked like when the pieces were snapped together.  Attach the plastic bands and...

 

Kinder egg toy spinning

 

The pieces fit together to make a spinning top.  Well done if you guessed correctly!

Unfortunately during the operation (diagnostic shellotomy) the egg suffered from Acute Total Ingestion (ATI) and sadly did not survive.

 

Happy Easter!

 

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