Clandestine charisma of the charm needles: a radiologist's challenge

A 94-year-old Korean woman was seen in the Emergency Department after a fall. CT examination of the maxillofacial region found multiple small linear metallic densities in the subcutaneous soft tissues of the face. The appearance of these densities was unchanged when compared to a study performed 2 years prior; however, the imaging interpretations of these densities were markedly different. Additional imaging during the course of her hospital stay demonstrated numerous similar densities in the breasts, abdomen, hips, and legs-finally diagnosed as "charm needles." Although common practice in Southeast Asia, with ever increasing globalization, these needles, or "susuks," are being seen with greater frequency in North America. Here, we review the imaging appearance of a bizarre case of these charm needles so as to raise awareness of this potential diagnostic challenge and help the radiologist avoid confusion when interpreting images.