Law Emily,  Luo Yu

Final Pr. ID: Poster #: CR-025

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. Read More

Authors:  Law Emily , Luo Yu

Keywords:  foreign body, MRI, US

Alhashmi Ghufran,  Gupta Anita,  Trout Andrew,  Dillman Jonathan

Final Pr. ID: Alt #: 001

Ultrasound shear wave elastography (US SWE) can be used to noninvasively measure liver stiffness. US SWE is a potentially useful technique for diagnosing and monitoring liver fibrosis, obviating the need for liver biopsy in some patients. When compared to MR elastography (MRE), US SWE is lower cost, portable, and does not need sedation/anesthesia. US SWE measurements can vary by method (point vs. 2D) and vendor. Few studies have defined cut-off values for detecting fibrosis in pediatric patients using US 2D SWE. This study aims to evaluate the diagnostic performance and define cut-off values of US 2D SWE for the detection of liver fibrosis in pediatric patients, using Toshiba (Canon) Aplio 500 and Aplio i800 systems. Read More

Authors:  Alhashmi Ghufran , Gupta Anita , Trout Andrew , Dillman Jonathan

Keywords:  2D US shear wave elastography, Liver fibrosis, Pediatric