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Soft Tissue Foreign Bodies Ultrasound

Soft Tissue Foreign Bodies Ultrasound

Penetrating injuries and suspected retained foreign bodies are a common reason for emergency department visits. Sonography is a useful modality in the detection and localization of radiolucent foreign bodies in soft tissue which can avoid misdiagnosis during primary emergency evaluation.

Ultrasonography (US) allows the detection of a variety of soft-tissue foreign bodies, including wood splinters, glass, metal, and plastic, along with an evaluation of their associated soft-tissue complications.

Which ultrasound scanner is used to detect foreign bodies in soft tissue?

A high-frequency (7.5-MHz and higher) SIFULTRAS-5.34 linear-array transducer is optimal for US evaluation of soft-tissue foreign bodies. The device offers improved spatial resolution, achieving anatomic detail of small structures with high accuracy, and may identify foreign bodies (FB) under 1mm in diameter.

The US allowed localization of a foreign body superficial to the flexor digitorum profundus tendon, and removal was easily accomplished in the emergency department.

In another patient, the US allowed localization of a foreign body superficial to the flexor digitorum profundus tendon but also demonstrated flexor tenosynovitis, which necessitated surgical incision and drainage. The US allowed correct identification of a complete rupture of the posterior tibial tendon secondary to laceration by a glass foreign body.

Further, ultrasound allows examination of the surrounding muscles, tendons, ligaments, and neurovascular structures and assessment of associated injuries. Soft-tissue infection is by far the most common complication of a penetrating foreign body, with nerve injury a distant second.

The US allowed identification of foreign bodies in the soft tissues superficial to the intact plantar fascia and plantar tendons.

The area of interest is scanned in both the longitudinal and transverse orientations, with attention to the detection of a foreign body and its associated posterior acoustic shadowing or reverberation.

The US allows the determination of the precise location of the foreign body, as well as its size, shape, and orientation, and aids skin marking for removal. The surrounding soft tissues are also examined for fluid collections, tendon disorders, and injury to neurovascular structures.

For proper technique, requires a slow and meticulous examination, especially in cases of small FB less than 1cm in length, where they can be unnoticed, also in anatomical areas like hands and feet, where echogenic structures exist such as sesamoid bones that can result in false positives.

Another aspect to consider is that the echogenicity of a FB also varies according to the orientation of the long axis FB with respect to the skin. When the FB is parallel to the skin the visualization is maximum. Moreover, it should be noted that small punctate structures may correspond to bulky FB if the cutting plane was carried by the short axis, as for example in the case of thorns.

S is an inexpensive, portable, and readily available imaging modality for superficial soft tissues without the risk of ionizing radiation. US has emerged as the study of choice for the detection of radiolucent foreign bodies.

This procedure is usually done by emergency specialists or orthopedists.

Details

  • Los Angeles, CA, USA
  • Anna Brown