Penetrating foreign bodies are frequently encountered, most commonly, wood, glass, or metal slivers. Retained foreign bodies are often overlooked on initial examination and only 15% of wooden foreign bodies are detected by radiographic visualization such as X-ray, CT and MRI. Soft tissue infection is the most common complication of a penetrating foreign body. This case report describes sonographic evaluation of a retained wood splinter, ulnar artery occlusion and soft tissue inflammation of the left forearm. A 63-year-old male was caught under a falling tree branch while trimming trees. The left forearm was speared causing an open wound. Needle-nose pliers aided as a self-repair method to remove penetrating limbs and splinters. The patient presented to the emergency department 10 years’ post injury with pain, edema and erythema.
A left arm duplex was performed using cine-loop B mode imaging (Philips EPIQ), color and spectral Doppler using L9-3 linear array transducer. The area of interest was scanned in both longitudinal and transverse orientations, with attention to detection of a residual foreign body, evaluation of surrounding soft tissue, as well as, assessment of the arteries and veins.
Duplex imaging revealed a preserved echogenic linear foreign body measuring 2.5 x 0.2 cm in the mid left forearm with surrounding fluid collection and an ulnar artery occlusion with recanalization of flow. Surgical correlation confirmed the presence, size and location of a foreign body and associated fluid and debris. The wood splinter was surgically removed without complications.
Ultrasound is highly sensitive, inexpensive and effective for detection of wood, glass and metal foreign bodies, along with evaluation and assessment of surrounding soft tissues and associated arterial and venous obstructions caused by trauma. Ultrasound is the modality of choice for documenting precise localization, size and shape of foreign bodies.
Dianne Masri, Supervisor/ Vascular Technologist, Hoag Memorial Presbyterian Hospital