Foreign Body Imaging

Excerpt

Retained foreign bodies are a common presentation in both the emergency department as well as in the outpatient setting. While retained foreign bodies are usually superficial, they can be missed even when a well-trained clinician performs a thorough history and physical. Therefore, retained foreign bodies are often a cause of malpractice lawsuits in the emergency department.

Foreign bodies are often a complication of lacerations and other soft tissue injuries. Complications resulting from foreign bodies include inflammation, delayed healing, and damage to surrounding tissues. Organic foreign bodies, such as thorns, splinters, or spines, can cause severe inflammation, hypersensitivity reactions, and infection. These infections can be resistant to antibiotic treatment and require surgical removal of the foreign body for definitive treatment. The most frequent sites of involvement include the extremities, including the hand/wrist and feet/ankles.

Most foreign bodies are locatable during an extensive wound-probing physical exam. Imaging studies are necessary in cases of suspected but not identified foreign bodies. Imaging is especially necessary following the removal of multiple foreign body pieces or when wound exploration is not possible. Imaging modalities that can be used to detect foreign bodies include plain film radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound. Each modality has its strengths and weaknesses that vary depending on the composition material of the foreign body, as well as the object’s location.