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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: CR-025
MRI Detection of Wooden Foreign Body Missed on Ultrasound
Purpose or Case Report:
Ultrasound is the first line of study of radiolucent foreign bodies, such as wooden or organic foreign bodies. The reported sensitivity is up to 90-100%. However, the orientation, location, and size of such foreign bodies can pose challenges for accurate detection.
Case Presentation: We present a case of a 16-year-old girl who stepped on a small wooden stick, leading to a foreign body penetrating between her fourth and fifth toes, which was removed in the emergency room. Post-removal X-ray and ultrasound failed to identify any residual foreign body, and the patient was discharged home with antibiotics. However, persistent pain and progressive foot swelling prompted a return to the Emergency Room two weeks later. A repeat ultrasound showed increased soft tissue swelling, and hyperemia centered around the webspace of the fourth and fifth digits but failed to detect the foreign body. Subsequent MRI revealed a vertically oriented 1.7 cm long cylindrical structure with a diameter of 0.3cm, demonstrating a hypointense signal in all sequences and hyperintense signal and enhancement in the surrounding tissue compatible with the foreign body. In retrospect, a tiny echogenic focus corresponding to the end of the foreign body is present in a similar location on some of the images of both sonographic exams. The foreign body was surgically removed, and the patient completely recovered within a week.
Discussion: This case highlights the limitations of ultrasound in detecting wooden foreign bodies, particularly when they have a unique orientation, location, and small dimensions; in this case, the foreign body was found vertically oriented (thus perpendicular to the ultrasound probe surface) and between the toes. The ultrasound can only detect the tiny end of the foreign body, which can be easily missed or misinterpreted. With its excellent tissue characterization capabilities, MRI proved to be a valuable tool in this challenging scenario. While ultrasound remains a highly sensitive and specific tool, clinicians should consider additional imaging modalities when faced with challenging cases to avoid missed diagnoses and unnecessary complications.
Methods & Materials:
Results:
Conclusions:
Ultrasound is the first line of study of radiolucent foreign bodies, such as wooden or organic foreign bodies. The reported sensitivity is up to 90-100%. However, the orientation, location, and size of such foreign bodies can pose challenges for accurate detection.
Case Presentation: We present a case of a 16-year-old girl who stepped on a small wooden stick, leading to a foreign body penetrating between her fourth and fifth toes, which was removed in the emergency room. Post-removal X-ray and ultrasound failed to identify any residual foreign body, and the patient was discharged home with antibiotics. However, persistent pain and progressive foot swelling prompted a return to the Emergency Room two weeks later. A repeat ultrasound showed increased soft tissue swelling, and hyperemia centered around the webspace of the fourth and fifth digits but failed to detect the foreign body. Subsequent MRI revealed a vertically oriented 1.7 cm long cylindrical structure with a diameter of 0.3cm, demonstrating a hypointense signal in all sequences and hyperintense signal and enhancement in the surrounding tissue compatible with the foreign body. In retrospect, a tiny echogenic focus corresponding to the end of the foreign body is present in a similar location on some of the images of both sonographic exams. The foreign body was surgically removed, and the patient completely recovered within a week.
Discussion: This case highlights the limitations of ultrasound in detecting wooden foreign bodies, particularly when they have a unique orientation, location, and small dimensions; in this case, the foreign body was found vertically oriented (thus perpendicular to the ultrasound probe surface) and between the toes. The ultrasound can only detect the tiny end of the foreign body, which can be easily missed or misinterpreted. With its excellent tissue characterization capabilities, MRI proved to be a valuable tool in this challenging scenario. While ultrasound remains a highly sensitive and specific tool, clinicians should consider additional imaging modalities when faced with challenging cases to avoid missed diagnoses and unnecessary complications.
Methods & Materials:
Results:
Conclusions:
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Poster____CR-025.pdf
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