Percutaneous extraction of deeply-embedded radiopaque foreign bodies using a less-invasive technique under image guidance

Abstract

Radiopaque foreign bodies (RFBs) retained in soft tissue are a common clinical problem. Image-guided extraction plays a great role in this realm. We describe our experience in the management of RFBs imbedded deeply in soft tissue using a percutaneous less-invasive technique under fluoroscopic guidance. In all, 76 patients with 251 RFBs including gun pellets (n = 223), needle fragments (n = 4), and irregular metallic splinters (n = 24) underwent percutaneous extraction of RFBs with the modified technique, which consists of: (1) percutaneously gaining access to the RFB using an 18-gauge needle, several tapered dilators, and an outer cannula and (2) grasping and withdrawal of RFB using a forceps through the cannula. The following periods were 6 months to 6 years. The direct distance between RFB and skin was from 2.5 cm to 8.5 cm (average 4.8 cm). Every RFB was successfully removed with technique success rate of 100%. The RFBs measured 0.2 cm to 3.0 cm in length and 0.1 cm to 0.5 cm in width. The procedural time and exposure time of X-ray for each RFB extraction were 8 minutes to 15 minutes and 1 minute to 4 minutes (mean, 10 minutes and 2 minutes, respectively). The radiation doses for each RFB and patient were 15.64 mGy to 62.56 mGy and 15.64 mGy to 500.48 mGy (mean, 30.26 mGy and 72.47 mGy, respectively). Blood lead concentration decreased to normal one month after the procedures in four patients with preprocedural high level. No complications were observed during the procedures and the following periods. Percutaneous extraction of RFBs from deep soft tissue with the present technique is safe, effective, and minimally invasive.