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Case 3982

Soft-tissue foreign body (cactus thorn)

Author(s)

Brito J, Teixeira L, Neves S, Curvo-Semedo L, Caseiro-Alves F Departments of Radiology (JB, SN, LCS, FCA) and Orthopaedic Surgery (LT), Hospitais da Universidade de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal

Patient

female, 52 year(s)

Clinical Summary

A 52-year-old woman complained of pain, swelling and functional impairment on the second digit of the hand 6 weeks after she punctured the finger with a cactus thorn.

Clinical History and Imaging Procedures

A 52-year-old right-handed woman complained of pain, swelling and functional impairment on the proximal phalanx of the second digit of the right hand for several days. Six weeks before she punctured the ungloved finger with a cactus thorn in a domestic accident. She was treated with antibiotics and non-steroidal anti-inflammatory drugs, without complete regression of the symptoms. Plain radiograph and ultrasound (US) of the right hand were performed.

Discussion

Penetrating injuries and suspected retained foreign bodies are a common reason for emergency department visits. Detection is important because they may lead to serious infectious and inflammatory complications. Only 15% or less of wooden foreign bodies are detected with radiography. Those invisible on conventional radiographs can often be easily identified on sonograms. All soft-tissue foreign bodies are initially hyperechoic on sonography. If they are present in the soft-tissues longer than about 24 hours, the ensuing inflammatory reaction can create a hypoechoic rim around the echogenic foreign body. This rim of granulation tissue, edema, or hemorrhage, increases the conspicuity of foreign bodies on US. Sonographic artifacts also aid in identification. The artifact occurring deep to a foreign body depends primarily on its surface attributes rather than its composition. Smooth and flat surfaces produce dirty shadowing or reverberation artifact, whereas irregular surfaces and those with a small radius of curvature produce clean shadowing. Sonography plays an important role for the detection of non-opaque foreign bodies, and has been shown to accurately demonstrate their size, shape, and location. For radiopaque foreign bodies, US can provide more precise localization and improved assessment of the surrounding soft-tissues, depicting fluid collections, tendon disorders, and injury to neurovascular structures. In our case, sonographic description of the location and characteristics of the foreign body was valuable by minimizing surgical exploration, and a cactus thorn was surgically removed without complications.

Final Diagnosis

Soft tissue foreign body (cactus thorn).

MeSH

Foreign Bodies [C21.866.392]
Fingers [A01.378.800.667.430]

References

Boyse TD, Fessell DP, Jacobson JA, Lin J, van Holsbeeck MT, Hayes CW. US of soft-tissue foreign bodies and associated complications with surgical correlation. Radiographics. 2001 Sep-Oct;21(5):1251-6

Horton LK, Jacobson JA, Powell A, Fessell DP, Hayes CW. Sonography and radiography of soft-tissue foreign bodies. AJR Am J Roentgenol. 2001 May;176(5):1155-9

Lin J, Jacobson JA, Fessell DP, Weadock WJ, Hayes CW. An illustrated tutorial of musculoskeletal sonography: part 4, musculoskeletal masses, sonographically guided interventions, and miscellaneous topics. AJR Am J Roentgenol. 2000 Dec;175(6):1711-9

Failla JM, van Holsbeeck M, Vanderschueren G. Detection of a 0.5-mm-thick thorn using ultrasound: a case report. J Hand Surg [Am]. 1995 May;20(3):456-7

Gooding GA, Hardiman T, Sumers M, Stess R, Graf P, Grunfeld C. Sonography of the hand and foot in foreign body detection. J Ultrasound Med. 1987 Aug;6(8):441-7

Citation

Soft-tissue foreign body (cactus thorn), {Online}.

URL:

DOI: 10.1594/EURORAD/CASE.3982

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Published 26.10.2006
DOI 10.1594/EURORAD/CASE.3982
SectionMuskuloskeletal System
Case-TypeClinical Case
Views 20
Language(s)

Figure 1

X-ray

X-ray films shows soft-tissue swelling but no foreign body or bone changes.

Figure 2

Ultrasound.

Figure 3

Photograph of the surgical specimen.

Photograph of the surgical specimen shows an 8-mm-long cactus thorn.

Figure 1

X-ray

X-ray films shows soft-tissue swelling but no foreign body or bone changes.

Figure 2

Ultrasound.

Transverse sonogram of the dorsal ulnar aspect of second digit proximal phalanx shows a linear foreign body within soft-tissues consisting of almost parallel hyperechoic lines with 8-mm-long. The foreign body appears hollow due to strong peripheral echoes and lack of central echoes. It is surrounded by a small hypoechoic region, likely fluid.

Figure 3

Photograph of the surgical specimen.

Photograph of the surgical specimen shows an 8-mm-long cactus thorn.

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