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Short Communication

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

Published Online:



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.

Advances in knowledge:

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.


  • 1. Semple T, , Calder AD, , Ramaswamy M, , McHugh K. Button battery ingestion in children-a potentially catastrophic event of which all radiologists must be aware. Br J Radiol 2018; 91: 20160781. doi: Link ISIGoogle Scholar

  • 2. Litovitz T, , Whitaker N, , Clark L, , White NC, , Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics 2010; 125: 1168–77. doi: Crossref Medline ISIGoogle Scholar

  • 3. Tanaka J, , Yamashita M, , Yamashita M, , Kajigaya H. Esophageal electrochemical burns due to button type lithium batteries in dogs. Vet Hum Toxicol 1998; 40: 193–6. MedlineGoogle Scholar

  • 4. Littlehales E, , Levi E, , Mills N, , Metcalfe R, , Hamill J. Double button battery ingestion – The “macaroon” sign. J Pediatr Surg Case Rep 2018; 36: 36–9. doi: Crossref ISIGoogle Scholar

  • 5. Anfang RR, , Jatana KR, , Linn RL, , Rhoades K, , Fry J, , Jacobs IN. pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Laryngoscope 2019; 129: 49–57. doi: Crossref Medline ISIGoogle Scholar

  • 6. Voelker J, , Voelker C, , Engert J, , Schendzielorz P, , Hagen R, , Rak K. Severe tracheobronchial harm due to lithium button battery aspiration: an in vitro study of the pathomechanism and injury pattern. Int J Pediatr Otorhinolaryngol 2020; 139: 110431. doi: Crossref Medline ISIGoogle Scholar

  • 7. Jatana KR, , Rhoades K, , Milkovich S, , Jacobs IN. Basic mechanism of button battery ingestion injuries and novel mitigation strategies after diagnosis and removal. Laryngoscope 2017; 127: 1276–82. doi: Crossref Medline ISIGoogle Scholar

  • 8. DiMaio VJM, , DiMaio DJ. Fire deaths. In: DiMaio V. J. M, , DiMaio D. J, eds.Forensic pathology, second edition. Boca Raton, USA: CRC Press; 2001. pp. 367–87. CrossrefGoogle Scholar

  • 9. Ohhashi S, , Hattori Y, , Ueno N, , Shimizu K. A study on button type alkali manganese battery in Ringer’s solution – limited injury factor on the electric discharge in body –. J Otolaryngol Jpn 1995; 98: 1796–804(in Japanese). Google Scholar

  • 10. Guinet T, , Gaulier JM, , Moesch C, , Bagur J, , Malicier D, , Maujean G. Sudden death following accidental ingestion of a button battery by a 17-month-old child: a case study. Int J Legal Med 2016; 130: 1291–7. doi: Crossref Medline ISIGoogle Scholar

  • 11. Shinkawa N, , Nakano A, , Kakizaki E, , Hayashi S, , Sonoda A, , Yukawa N. To prevent button battery ingestion in children: tissue-damaging alkali is generated even with low voltage 1.5 V button battery. Nihon Iji Shinpo 2018; 4896: 20–2(in Japanese). Google Scholar

  • 12. Matsumoto K, , Jinzaki M, , Tanami Y, , Ueno A, , Yamada M, , Kuribayashi S. Virtual monochromatic spectral imaging with fast kilovoltage switching: improved image quality as compared with that obtained with conventional 120-kVp CT. Radiology 2011; 259: 257–62. doi: Crossref Medline ISIGoogle Scholar

  • 13. Punjabi GV. Multi-energy spectral CT: adding value in emergency body imaging. Emerg Radiol 2018; 25: 197–204. doi: Crossref Medline ISIGoogle Scholar

  • 14. Knight B. Electrical fatalities. In: Saukko P, , Knight B, eds.Knight’s forensic pathology. fourth edition. Boca Raton, USA: CRC Press; 2016. pp. 325–38. Google Scholar

  • 15. Yasui T, , Izumi H, , Takagi D, , Takeyama N, , Chishiro T, , Tanaka T, , et al.. Experimental and clinical study of the hazard by an alkaline battery ingestion. Jpn J Gastroenterol Surg, Nihon Shokaki Geka Gakkai zasshi 1984; 17: 586–94(in Japanese). doi: CrossrefGoogle Scholar

Volume 94, Issue 1128December 2021

© 2021 The Authors. Published by the British Institute of Radiology


  • RevisedAugust 30,2021
  • ReceivedFebruary 25,2021
  • AcceptedOctober 04,2021
  • Published onlineOctober 18,2021