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

Abstract

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.

The Wandering Charm Needle

“…Charm needles are often found incidentally on imaging performed for other indications. They typically appear as linear metallic densities measuring 0.5 -1 mm in diameter and 5-10 mm in length [2,3]. Variations in its appearance have been reported with previous published images showing a kink at its midpoint or a curvilinear U-shaped appearance [2,5].…”

“…The number of charm needles inserted varies with previously reported numbers ranging from a single needle to up to 200 needles in different anatomical locations [3]. A few (1-5) scattered charm needles is generally the norm; common locations include the orofacial region, breasts, chest, abdomen, pubic region, and limbs on radiographs (Figure 5) [3].…”

“…They were initially described in Muslim Malaysian females but are also found in Chinese and Indian people of both sexes. The practice is most commonly seen in the South East Asian countries of Thailand, Indonesia, Brunei, and Singapore [2,3].…”

“…Alternative medicine practitioners known as bo-mohs or shamans insert these charm needles classically via direct insertion under the skin [2,3]. This process involves a chanting ritual with massage of oil over the area of insertion.…”

“…Charm needles are usually composed of an alloy containing approximately 90% gold and copper (10%) to harden its composition; smaller amounts of aluminum and silver may be present. Diamonds (Figure 4) and other non-metallic material such as fruits, betel leaves, turmeric, pepper and shallots have also been used as charm needles and these may be radiolucent making it difficult to diagnose on imaging [2,3].…”