Type:
Educational Exhibit
Keywords:
Tissue characterisation, Outcomes, Foreign bodies, Localisation, Diagnostic procedure, Computer Applications-Detection, diagnosis, Ultrasound-Colour Doppler, Ultrasound, Digital radiography, Musculoskeletal system, Musculoskeletal soft tissue, Emergency
Authors:
E. Marín Diez1, Y. Lamprecht1, E. Montes Figueroa1, V. Fernandez-Lobo1, A. B. Barba Arce1, F. Pozo Piñon2, E. G. HERRERA ROMERO1, M. Pelaz Esteban1, E. GALLARDO AGROMAYOR2; 1Santander/ES, 2Santander, Cantabria/ES
DOI:
10.1594/ecr2018/C-2489
Background
Foreign bodies are objects originating outside the body and retained in patient´s tissues due to accidents and injuries.
Patients with penetrating wounds and suspected retained foreign bodies are a common reason of consultation in emergency rooms.
The most common retained materials are wood,
glass and metal (Fig.
1).
General evaluation of punctured wounds and soft tissue lacerations includes:
- Detailed history and physical examination.
- Radiographic investigation to rule out the presence of a foreign body.
Radiography is useful to demonstrates radiopaque material such as glass,
metal,
stone and some plastics,
although precise depth and location can be difficult to determine. Thirty-eight percent of retained foreign bodies are overlooked at initial examination in the emergency room.
Both,
glass and wood,
can be radiolucent and difficult to demonstrate on radiograph images.
Glass accounts for up to 50% of missed foreign bodies using physical examination and radiographs.
Only 15% or less of wooden foreign bodies are detected with radiography.
When the clinical suspicion of a foreign body remains high,
despite negative radiographs,
other imaging modalities are needed for diagnosis.
Ultrasound (US) has demonstrated high sensitivity and specificity in identifying and localizing both radiopaque and,
more importantly,
radiolucent foreign bodies.
US is especially useful in certain cases (Table 1).
High-frequency linear transducers (7.5 MHz or higher) are needed to localize a retained foreign body.
Correlation with radiographs is always recommended.
US also plays an important role in foreign body removal due to its ability for real-time localization relative to surface anatomy.
Detection and removal of retained foreign bodies is important,
because they can lead to infectious and inflammatory complications.