Ultrasonography (US) allows detection of a variety of soft-tissue foreign bodies, including wood splinters, glass, metal, and plastic, along with evaluation of their associated soft-tissue complications. Cases were obtained from the authors' clinical experience over the past 1.5 years. Surgical correlation allowed confirmation of the presence of a foreign body and associated soft-tissue complications in all cases. All of the foreign bodies were echogenic when imaged with US. A surrounding hypoechoic rim and posterior acoustic shadowing or reverberation aided detection in several cases. Associated soft-tissue complications included a complete laceration of the posterior tibial tendon and septic flexor digitorum tenosynovitis. US allows accurate and efficient detection of radiolucent soft-tissue foreign bodies and aids assessment of their associated complications. For radiopaque foreign bodies, US can provide more precise localization and improved assessment of the surrounding soft tissues. US has emerged as the study of choice for detection and localization of radiolucent soft-tissue foreign bodies and can aid assessment of their associated complications.

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A 38-year-old woman, in otherwise excellent health, had a 4-year history of left lateral chest wall pain. Physical examination demonstrated a nontender rib cage with normal respiratory movement. Radiographs of the left ribs were obtained ( Fig 1). A triple-phase whole-body bone scan demonstrated focal increased uptake within the left sixth rib and right renal enlargement, with no other abnormalities.One year later, the patient had increased left-sided rib pain after an embrace from her husband. A follow-up rib series demonstrated no apparent change. Computed tomography (CT) of the left ribs was performed (Fig 2). A repeat bone scan demonstrated interval decrease in the focal uptake within the left sixth rib and an enlarged distorted right kidney. A radiographic bone survey was performed (Figs 3, 4). Similar findings were also seen in the contralateral humerus, thoracolumbar spine, and pelvis. Subsequent contrast materialenhanced CT of the abdomen was performed (Fig 5). Results of all laboratory tests, including those of serum and urine electrophoresis, did not disclose any abnormalities. CT-guided percutaneous biopsy of a pelvic bone lesion was performed (Fig 6). Figure 1 demonstrates a lytic expansile lesion within the lateral aspect of the left sixth rib with some cortical thinning. CT (Fig 2) findings of a study performed a year later suggested possible previous pathologic fracture of the sixth rib through the otherwise intact cortex, and there was no evidence of calcified matrix or associated soft-tissue component. Lytic areas with lobular margins were also seen in a thoracic vertebral body with minimal sclerotic margins. In addition, the presence of several small round low-attenuation areas at the margins of the rib and vertebral body lesions suggest vascular channels. From a bone survey, a lateral radiograph of the skull (Fig 3) demonstrated round and ovoid lytic lesions with nonsclerotic but well-defined margins and some lobulation. Figure 4 shows a lytic lesion within the proximal left humeral diaphysis. The lesion has a honeycombed appearance with minimal sclerotic margin and well-defined margins. Additional lytic lesions are present in the midhumeral diaphysis. Similar abnormalities were identified in the contralateral humerus, the thoracolumbar spine, and the pelvis. A subsequent Part 1 of this case appeared 4 months previously and may contain larger images. IMAGING FINDINGS