Abstract
Removal of foreign bodies from soft tissues in emergency is very challenging and becomes more problematic when it is radiolucent. Blind exploration is sometimes hazardous for patients especially when it is in proximity to a vessel or a nerve or an overlying tendon. The purpose of this study was to determine the accuracy of ultrasonography (USG) in detecting radiolucent soft tissue foreign bodies in the extremities. From January 2014 to January 2016, 120 patients with either a positive history or clinically suspected soft tissue foreign body and negative radiography were evaluated by USG with a high-frequency (13–6 MHz) linear-array transducer. The sonographic findings were used to guide surgical exploration. Out of 120 patients who underwent surgical exploration, USG was positive in 114 cases, and foreign body was retrieved in 108 cases, and among the six cases where USG was negative, foreign body was retrieved from one case. In one case with strong clinical suspicion of foreign body USG was falsely negative. Majority of foreign bodies were removed from foot (69 cases) and hands (26 cases), and rest of foreign bodies were removed from ankle (4 cases), wrist (3 cases), thigh (2 cases), leg (1 case), knee (2 cases), forearm (2 cases). Accuracy, sensitivity, and positive predictive value were determined as 94.16, 99.08, and 94.13%, respectively. The real-time high-frequency USG is a highly sensitive and accurate tool for detecting and removing radiolucent foreign bodies which cannot be visualized by routine radiography.
Highlights
Penetrating foreign bodies are common in patients visiting emergency departments [1, 2]
The missed foreign body may remain asymptomatic for prolonged periods or else lead to a wide range of complications including pain, abscess, chronic discharging wound, necrotizing fasciitis bone and joint destructive lesions granulomas with impairment of tendon mobility or triggering of digits migration delayed tendon ruptures, neurodeficits, pyogenic granulomas, vascular events, massive soft tissue injury, and lawsuits [3,4,5,6,7,8,9,10,11,12,13,14,15]
One hundred and twenty patients underwent surgical exploration; among them 114 patients had a positive USG, and foreign body was retrieved from 108 patients, and in the rest of six patients in whom USG was positive, five had underwent at least one previous exploration
Summary
Penetrating foreign bodies are common in patients visiting emergency departments [1, 2]. Farming being the most common job among the population in Kashmir with practice of working bare footed in orchards, the probability of penetration of tree splinters as a radiolucent foreign body in the extremities, especially the sole of the foot, is high. A radiolucent foreign body such as wood frequently remains undetected [16]. Sonography has a reported sensitivity of 95% for detection of foreign bodies [18, 19]
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