Occult traumatic impaled foreign body, a challenging diagnosis of severe chronic lower extremity radicular pain

Abstract

The investigation of embedded soft tissue foreign bodies relies heavily on radiological imaging. The prompt identification of these objects is critical as retained foreign bodies may lead to serious infection or chronic debilitating pain depending on anatomical location. In this report, we present a case of a radiographically occult traumatically implanted foreign body in a 15-year-old female after a high-speed motor vehicle accident. Initial computed tomography (CT) scan was unremarkable and exploration under anesthesia demonstrated no other significant findings, yet the patient continued to suffer severe refractory radicular pain with marked limitation of daily function. It was not until 12 weeks after the accident that a magnetic resonance image (MRI) of the pelvis revealed a deep sinus tract with central low magnetic resonance (MR) signal, raising suspicion for a retained foreign body. A 10-centimeter plastic foreign body extending from the patient's coccyx to the sciatic foramen was identified and surgically removed resulting in immediate symptom relief. This case illustrates that the detection of a retained foreign body is not always straightforward and multiple imaging modalities may be necessary for accurate diagnosis. We also discuss the most appropriate diagnostic imaging algorithm when a foreign body of the musculoskeletal system is suspected.

Nearly Missed Pharyngeal Foreign Body: A Three-Year-Old van Gogh

“…CT scan findings were key in the diagnostic procedure in our case. Nevertheless, some types of plastic have similar attenuation levels to soft tissues, making them undetectable via CT scan when implanted in muscular tissues, for example [ 1 , 6 ]. In such cases, MRI can be superior to CT scan for detecting foreign bodies.…”

“…In such cases, MRI can be superior to CT scan for detecting foreign bodies. As an illustration, Kartiko M et al recently reported a case in which a 10-cm plastic foreign body lodging in the deep soft tissues of the pelvis was overlooked on a CT scan and was not identified until an MRI was performed [ 6 ].…”

“…Early foreign body detection is fundamental in minimizing these complications [ 4 , 6 ]. However, the diagnosis might be tricky in children because of some peculiar aspects, such as restricted patient history and clinical examination, and limited imaging modalities might delay the diagnosis and make it a real challenge [ 1 ].…”