Pediatric emergency medicine trisk 4526 4526
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FIGURE 131.33 Cobblestoning in soft tissue.
Foreign-Body Identification and Removal
Ultrasound can be used for detection of radiolucent foreign bodies and accurate
real-time two-dimensional localization of all soft tissue foreign bodies. Real-time
sonographic visualization can guide percutaneous removal of a soft tissue foreign
body, minimizing surgical exploration.
Technique
The technique used for subcutaneous foreign body identification is similar to
evaluation for soft tissue infection. A high-frequency linear transducer is
preferred and the object should be identified in two planes. If an object is very
superficial, a water bath or a “stand-off pad” can be used to elevate the transducer
off of the area of interest, improving resolution. All soft tissue foreign bodies are
initially hyperechoic on sonography. The depth and size of the foreign body
should be measured and any relationship to surrounding nerves and vessels
should be noted. Surrounding granulation tissue, edema, or hemorrhage can
appear as a hypoechoic halo increasing visibility of the object. Typically objects
that are small or irregular, such as toothpicks or pencil tips, create clean shadows,
while objects with large smooth surface, such as glass or metal, create
reverberation artifacts such as comet tails. To remove a foreign body using realtime ultrasound guidance, the transducer should be placed so that the center
