1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 26 Foreign Bodies Abdomen and Superficial Structures

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Objectives Identify and give examples of different types of soft tissue foreign bodies based on composition. Explain sensitivity and specificity. List the important information the sonographer should obtain from the patient interview and patient chart prior to providing a comprehensive sonography evaluation. Differentiate the different sonographic appearances of soft tissue foreign bodies based on composition, location, age, and artifacts.

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Objectives Describe the role of the sonographer prior to, during, and following sonography guided foreign body removal. Explain the limitations of sonography and the advantages of other imaging modalities used to image soft tissue foreign bodies.

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Composition of Foreign Bodies OrganicPlant material (thorn, wood, etc.) Animal products (bee stinger, barb, etc.) InorganicGlass, gravel, plastic (acrylic), pencil lead, graphite, etc. MetallicWire, needle, fish hook, etc. Radiography detects only 15% or less of radiolucent foreign bodies (wood, plastic, glass, and cactus spine)

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Transducer Large Footprint Screening 7-12 MHz High Resolution

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Increasing Near Field Length Water Bath Technique Increase visualization of skin surface.

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Increasing Near Field Length

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Edge Shadowing Artifacts

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Speckle Reduction Imaging & Hyperemic Flow Inflammatory Rxn

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Using Anatomy to Locate Foreign Bodies

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Foreign Body Location

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Age of the Foreign Body Acute PhaseInjury less than 3 days Bright, Echogenic, Shadowing After 24 hours – hypoechoic halo develops (inflammatory rxn) Intermediate PhaseInjury within 3 to 10 days Air replaced by fluid, No shadowing, Hypoechoic halo is prominent Chronic PhaseInjury more than 10 days Dense granular material develops encapsulating foreign body - Granuloma Clean Shadow

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Shadowing

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Hypoechoic Rim

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Granuloma Formation

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Appearance of Retained Foreign Bodies 1.Echogenic with clean shadowing 2.Echogenic with dirty shadowing 3.Echogenic with distal ring down 4. Echogenic with hypoechoic ring surrounding the object

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sonogram of Foreign Body and Air Mimicking Foreign Bodies

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Documenting Foreign Body Location

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sonography-Assisted Removal ForcepsNeedle

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Limitations Varying imaging angles can decrease differentiation from bone Wound exploration or irrigation may decrease air bubbles in field of view –Lidocaine injection False positives

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Summary The sonography examination relies on the skill, knowledge, and accuracy of the sonographer who pays attention to the composition, location, age, and artifacts associated with foreign bodies. The experienced sonographer has an important role prior to, during, and following sonography-guided foreign body removal.

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Summary Recognizing foreign body detection and removal is a unique and evolving application of emergency sonography. Sonography should become the main imaging tool used for the detection and localization of soft tissue foreign bodies because of its sensitivity, it is noninvasive, and it provides a high-resolution, real time evaluation.