Ultrasound in Emergency MedicineBedside Ultrasound Aids Identification and Removal of Cutaneous Foreign Bodies: A Case Series
Introduction
A variety of imaging modalities are available to the emergency physician in the evaluation of patients with cutaneous foreign bodies (FBs). Plain radiography is quick and inexpensive, but does not reliably identify certain types of FBs and gives no information about location relative to anatomic structures other than bone. Computed tomography (CT) may further define the anatomy, but is costly, often impractical, and exposes the patient to radiation. Magnetic resonance imaging is also costly and is not available for this purpose in most emergency departments (EDs). In this setting, bedside ultrasound offers high-definition imaging, and is inexpensive, easy, and does not expose the patient to radiation.
The following cases demonstrate the utility of ultrasound in identifying soft tissue foreign bodies, as well as the decision-making process regarding bedside surgical retrieval in the ED.
Section snippets
Case 1
A 12-year-old girl presented to the ED 2 h after a wooden FB became lodged in her third left digit while running her hand down a wooden railing. Her family attempted to remove the splinter prior to coming to the ED, but the patient still complained of a FB sensation.
Upon arrival, the patient was extremely anxious and had two small puncture wounds on either side of her left third digit, just proximal to the distal interphalangeal (DIP) joint. She demonstrated full range of motion, normal
Discussion
Traumatic soft tissue injury, including penetrating injuries and lacerations, are common reasons for ED visits. These injuries are often complicated by retained foreign bodies, most commonly wood, glass, metal, plastic, or gravel. Detection of foreign bodies can be difficult, because they may initially be asymptomatic, and some objects are radiolucent. In one retrospective study of 200 patients with retained foreign bodies, 38% were overlooked on the initial visit, resulting in inflammation,
Why Should an Emergency Physician Be Aware of This?
Bedside ultrasound is an effective tool for the emergency physician in the identification and selective removal of cutaneous FBs. Routine use of this technology will prevent missed foreign bodies and their resultant complications.
Acknowledgments
No external grants support was provided for this case series. Drs. Budhram and Schmunk co-authored this case series and prepared the accompanying figures. No external assistance was provided. No institutional review board approval or exemption was required by our institution because the case series involved fewer than 4 patients.
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