Role of ultrasound in detection of radiolucent foreign bodies in extremities

Abstract

Removal of foreign bodies from soft tissues in emergency is very challenging and becomes more problematic when it is radiolucent. Blind exploration is sometimes hazardous for patients especially when it is in proximity to a vessel or a nerve or an overlying tendon. The purpose of this study was to determine the accuracy of ultrasonography (USG) in detecting radiolucent soft tissue foreign bodies in the extremities. From January 2014 to January 2016, 120 patients with either a positive history or clinically suspected soft tissue foreign body and negative radiography were evaluated by USG with a high-frequency (13–6 MHz) linear-array transducer. The sonographic findings were used to guide surgical exploration. Out of 120 patients who underwent surgical exploration, USG was positive in 114 cases, and foreign body was retrieved in 108 cases, and among the six cases where USG was negative, foreign body was retrieved from one case. In one case with strong clinical suspicion of foreign body USG was falsely negative. Majority of foreign bodies were removed from foot (69 cases) and hands (26 cases), and rest of foreign bodies were removed from ankle (4 cases), wrist (3 cases), thigh (2 cases), leg (1 case), knee (2 cases), forearm (2 cases). Accuracy, sensitivity, and positive predictive value were determined as 94.16, 99.08, and 94.13%, respectively. The real-time high-frequency USG is a highly sensitive and accurate tool for detecting and removing radiolucent foreign bodies which cannot be visualized by routine radiography.

Retrospective evaluation of 377 patients with penetrating foreign body injuries: a university hospital experience (a present case of missed sponge foreign body injury)

“…USG failed to detect a deep FB which was observed by MRI due to soft tissue infection and fluid collection around a small piece of sponge. A similar case was reported with a different scenario after two years from the injury [17]. Previous comparative studies of different radiological investigations were done in vitro.…”

“…Although early diagnosis and prompt removal of foreign bodies are required to prevent complications, there is no consensus related in the approach of detecting of FBs. Recently a procedure is reported in the literature at identifying FBs [17,33,34]. Although radiography holds excellent sensitivities for radiopaque foreign bodies, the accuracy, sensitivity, and positive predictive value of ultrasound in detection of non-radiopaque FBs were found as 94%, 99% and 94%, respectively [35,36].…”

Circumferential constriction ischaemic syndrome (CCIS): A potentially reversible ischaemic condition of lower limb

“…Radiolucent foreign bodies are visualized as hyper-echoic foci with accompanying acoustic shadows. 8 In ultrasonography, acoustic shadowing can differentiate foreign body from scar tissue, gas bubble and normal intermuscular fascia, because they are void of acoustic shadowing. Accuracy, sensitivity and positive predictive value for foreign bodies by ultrasonography were determined as 94.16%, 99.08% and 94.13%, respectively.…”

“…Accuracy, sensitivity and positive predictive value for foreign bodies by ultrasonography were determined as 94.16%, 99.08% and 94.13%, respectively. 8 The authors suggested that ultrasonography should be considered in non-healing wound to screen for underlying foreign body.…”

Detection of foreign objects in milk using an ultrasonic system

“…Ultrasonic has been successfully been applied for freezing, cavitation, emulsification and thermosonication for many types of food products [5][6][7]. Several investigationson foreign body detection using ultrasonic sensor had been carried out as reported by Correia et al [8], Zhao et al [9], Pallav et al [10],Leemans and Destain [11], Tantray et al [12] and Polat et al [13], Mcclements [14],Hassler and Homayoon [15], Le Coz et al [16],Iuliano [17], Liu et al [18], Liaw et al [19], Makinde et al [20], Holmes et al [21], Melo et al [22], Khan et al [23], Prabhakar et al [24],Rodrigues et al [25], Franchini et al [26], Pandey [27], Aftab et al [28], Gounder and Tan [29], Sadaka et al [30], Fasina et al [31], Khan et al [32], Mitev et al [33], Roux et al [34], Nakib et al [35], Rathore [36], Singleton et al [37], Mahesh et al [38], Ezenwa [39], Natung [40] and Mustapha [41], In this paper, two common foreign bodies materials e.g. steel and rubber with different sizes were used to investigate the sensor voltage and voltage loss at the ultrasonic receiver.…”