Ultrasound-guided foreign body localization and removal using a finder needle
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CASE REPORT
Ultrasound-guided foreign body localization and removal using a finder needle Jonathan K. L. Mau • Mathew Nelson Christopher Raio
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Published online: 6 November 2009 Ó Springer-Verlag 2009
Abstract The localization and removal of a superficial foreign body is a common challenge that emergency physicians encounter. The use of ultrasonography to detect superficial foreign bodies has been well documented, but with varying success. This case report demonstrates the use of a finder needle, placed under ultrasound-guidance, to assist in the localization and removal of a glass foreign body that could not be identified after extensive wound exploration alone. Keywords Ultrasound Foreign Body Localization Finder Needle
Introduction In the emergency department, the detection of a superficial foreign body is a common and important task. There are several modalities available for identifying foreign bodies. While the use of ultrasonography to detect foreign bodies has been described with varying success, it may be the most reliable method for detecting nonradiopaque material [1]. If not identified and removed, superficial foreign bodies may cause substantial morbidity and represent a significant medicolegal liability [2]. The use of bedside ultrasonography is effective not only for identifying, but more importantly may be useful in the localization and removal of superficial foreign bodies.
J. K. L. Mau (&) M. Nelson C. Raio Department of Emergency Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA e-mail: [email protected]
Case report A 24-year-old male presented to the emergency department after breaking his car door window with his elbow. His vital signs were within normal limits, and his only complaint was a left arm laceration. On physical examination, there was a 4 cm laceration on the posterior aspect of his left arm, just proximal to the olecranon. The patient’s neurovascular examination was normal, with full range of motion and strength in the arm. A 3-view plain radiograph of the left elbow was performed, and identified 2 small radio-opaque foreign bodies (Fig. 1). After extensive exploration of the wound, the emergency physician was unable to locate the foreign bodies. With the use of focused emergency bedside ultrasonography, the emergency ultrasound fellow was immediately able to localize the foreign body, which was lodged 2 cm distal to the wound edge and approximately 1 cm beneath the skin (Fig. 2). Under ultrasound-guidance, a 22-gauge finder needle was then inserted adjacent to the foreign body (Fig. 3). The emergency physician, using the finder needle as a guide, extended the laceration distally and was able to dissect down to the foreign bodies. Two pieces of glass measuring 4 mm 9 3 mm were removed from the patient’s wound.
Discussion Locating and removing a foreign body is a challenge that emergency physicians commonly encounter. Patients presenting with an open wound should always raise suspicion for a potentially embedded foreign b
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