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case_images: Case 1: Hematoxylin & eosin (H&E) stained section of fibroadipose tissue showing black granular material in aggregates. Original magnifications at 10x and 600x.
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case_images: The H&E section demonstrated black granular material that was clustered in aggregates (Figure 2).
case_images: Case 1: Scanning electron microscopy (SEM) image and energy-dispersive X-ray analysis (EDXA) of the granular material embedded in the fibroadipose tissue demonstrating the presence of tungsten and lead. SEM original magnification 900x.
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case_images: By SEM-EDXA, this black granular material was attributed to tungsten and lead (Figure 3). 
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case_images: Case 2: Hematoxylin & eosin (H&E) stained section containing (A) pausicellular fibrous tissue and scattered black fragments and (B) necrotic debris admixed with black material, but no significant inflammation. Original magnification 200x.
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case_images: The H&E stained sections were examined by light microscopy, and demonstrated dense fibrous tissue (capsule) surrounding the fragment composed of paucicellular fibrous tissue and scattered black metal fragments (Figure 4A). Furthermore, the histologic analysis demonstrated some focus of necrotic debris admixed with the black material, but no significant inflammation was detected (Figure 4B). 
case_images: Case 2: Scanning electron microscopy (SEM) image of the DU fragment and energy-dispersive X-ray analysis (EDXA) of a region of tissue with granular black fragments demonstrating the presence of uranium and titanium. Depleted Uranium particles were measured in in the range of 0.8-1.69 microm. SEM original magnification 3,000x.
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case_images: By SEM-EDXA analysis of the tissue sections, the granular black fragments demonstrated both uranium and titanium (Figure 5). Figure 5 illustrates the SEM photomicrograph of a region of tissue removed close to fragment 1, demonstrating uranium and titanium containing particles as determined by SEM-EDXA.
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case_images: Case 3: Lateral radiographs of the left thigh and femur of a 24 year-old male service member demonstrating opacities representing retained metal and composite material fragments in the soft tissues of the posterolateral thigh due to an improvised explosive device blast.
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case_images: Case 3, is a 24-year-old male with retained fragments from a wound to the lower extremity (Figure 6).
case_images: Case 3: Confocal laser Raman microprobe spectrum of a non-metallic fragment identified as bisphenol-A-polycarbonate.
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case_images: A second fragment was determined to be a polymer identified as bisphenol-A-polycarbonate (CAS Number: 25037-45-0) by confocal laser Raman microspectroscopy (CLRM) (Figure 7).
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case_images: Case 4: Gross photograph (A) of a retained fragment (black area) surrounded by fibroadipose tissue (white area); (B) Hematoxylin & eosin (H&E) stained section demonstrating granular black fragments. Scanning electron microscopy image and EDXA spectrum (C) of a tissue section demonstrating the presence of a metallic lead fragment within the fibroadipose tissue.
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case_images: A gross photograph of the removed fragment (irregularly shaped and black in color) surrounded by soft tissue is shown in Figure 8A. The H&E stained section demonstrate black fragments scattered throughout the tissue (Figure 8B) including birefringent (birefringence is responsible for double refraction whereby a ray of light is split by polarization into 2 rays taking slightly different paths when incident upon a birefringent material) foreign bodies. By SEM-EDXA, the black scattered fragments were identified as being composed of lead, in both the excised fragment and the surrounding tissue (Figure 8C). 
case_images: Case 4: Confocal laser Raman microspectroscopy spectra demonstrating the presence of PbO (trace A) and CaSO4 (trace B) within a tissue section.
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case_images: To our knowledge, this is the first time that this form of lead has been demonstrated by Raman microspectroscopy to be formed in tissues as a result of exposure to lead. Adjacent to the metal fragment, a deposition of brown to dark refractive foreign bodies were observed (see the insert on Figure 9). These inclusions were identified by Raman microscopy (Trace B) to be calcium sulfate (CaSO4) deposition (Raman peak of 1,012 cm-1), which commonly occurs near retained fragments in response to the presence of the foreign material.