Arch Orthop Trauma Surg (1990) 110:24-25
ofOrthopaedic .dTrauma Surgery @ Springer-Verlag 1990
Ultrasonographic detection of foreign bodies in soft tissue A human cadaver study P. J. H. Blyme, T. Lind, K. Schantz, and P. Lavard Department of Orthopaedics T, Gentofte Hospital, University of Copenhagen, DK-2900 Hellerup, Denmark
Summary. T h e usefulness of ultrasound in the detection of foreign bodies was examined in a blind study in h u m a n cadavers using glass, plastic and w o o d as foreign bodies. Of 65 foreign bodies placed in 102 cicatrices, 58 were f o u n d using a 5 M H z transducer. T h e sensitivity was 89% and the specificity 93% making ultrasound a useful clinical tool for this purpose.
D e t e c t i o n of minute foreign bodies in soft tissues is a c o m m o n clinical p r o b l e m and can be difficult, especially if the foreign bodies are invisible on radiographs. P r o m ising results concerning the use of ultrasound in the detection of foreign bodies have b e e n presented in a few case histories [3, 5, 8] and in some in-vitro investigations [2, 4, 6, 7]. N o n e of these investigations, h o w e v e r , were blind or c o n d u c t e d in h u m a n soft tissue. To evaluate the clinical usefulness of the technique, we present a blind study of ultrasonographic detection of foreign bodies in h u m a n cadavers.
Methods and materials In 17 thighs from 9 human cadavers, 102 incisions were made (6 in each thigh). Foreign bodies of wood, glass or plastic were inserted randomly. Incisions without foreign bodies were cannulated with a 2 mm trochar, simulating damage to the soft tissue made by a noncaptured foreign body. A total of 65 foreign bodies were placed (glass: 14; wood: 27; plastic: 24), ranging from 3 mm to30 mm in size (Table 1). All the incisions were examined with a 5-MHz ultrasonic transducer (Picker CS 9500) and acoustic gel. The series was performed blind: one of the authors inserted the foreign bodies and another did the sonographic examination unaware of the content. Palpation of the area was not allowed during the test. Offprint requests to: Dr.P.J.H.Blyme, Violvej 26 B, DK-2820
Gentofte, Denmark
Results O f the 65 foreign bodies implanted, 58 were found, giving a sensitivity of 89% and a specificity of 93%. T h e results and confidence limits in relation to the type of foreign b o d y are shown in Table 2. T h e right diagnosis was achieved in 91 of 102 cases. T h e characteristic ultrasonographic a p p e a r a n c e of glass is shown in Fig. 1. T h e ultrasonographic appearances of plastic and w o o d are very similar and are shown in Fig. 2 and 3.
Discussion In a retrospective study [1] describing 200 cases of retained foreign bodies, the most c o m m o n materials were
Table 1. Number, size and localization in thigh of 65 foreign bodies evaluated ultra sonographically Material
n
Size (median) (mm)
Depth (mm)
Wood Plastic Glass
27 24 14
5 x 1 × 1-30 × 2 × 2 (10 × 2 x 2) 5 x 1 x 1-20 x 2 x 3 (10 × 2 x 2) 3x2×2-10×4×2 (5×3×2)
2-40 2-40 2-40
Table 2. Results of ultrasonographic of foreign bodies in human soft tissue Material
Right diagn,
Wrong diagn,
Total
Confidence limits (95%)
Wood Plastic Glass Empty
24 20 14 33
3 4 0 4
27 24 14 37
71- 98 63- 95 77-100 75- 97
Total
91
11
102
81- 94
P. J. H. Blyme et al. : US Detection of foreign bodies in human soft tissue
25
Fig.1. Glass splinter (5 x 3 × 2 mm) located at a depth of 6 ram.
Acknowledgement. We thank Dr.S0ren Hancke, Department of
Arrow, typical comet tail of echo reverberation. A, skin
Ultrasound, Gentofte Hospital, University of Copenhagen, for advice and technical assistance.
Fig. 2. Foreign body of plastic (5 × 3 × i mm) located at a depth of 8 ram. The small arrow shows a hyperechoic area corresponding to the surface of the plastic body. The large arrow shows the shadow. A, skin Fig. 3. Foreign body of wood (10 × 2 × 2 mm) located at a depth of t0 ram. The small arrow shows the foreign body, the large arrow shows shadow. A, skin
w o o d , glass a n d m e t a l . M e t a l is visible o n r a d i o g r a p h s . I. S u r a m o a n d M. P a m i l o [7] f o u n d t h a t f o r e i g n b o d i e s o f v a r i o u s m a t e r i a l s (glass, w o o d , plastic, etc.) r e f l e c t e d m o r e i n t e n s e e c h o e s (5 M H z ) t h a n t h e t r a n s m i s s i o n m e d i u m ( m i n c e d m e a t ) w h e n s i t u a t e d in f a v o u r a b l e positions, b u t t h e clinical u s e f u l n e s s was n o t e v a l u a t e d . O u r s t u d y i n d i c a t e s t h e usefulness of u l t r a s o u n d in the clinical d e t e c t i o n of f o r e i g n b o d i e s . A s s h o w n in Fig. 1, glass causes a t y p i c a l c o m e t tail o f r e v e r b e r a t i o n echoes [2], while w o o d a n d plastic p r o d u c e i d e n t i c a l h y p e r e c h o i c p a t t e r n s a n d s h a d o w s . T h e l a t t e r can b e difficult to distinguish f r o m s h a d o w s c a u s e d b y air t r a p p e d in t h e cicatrices. A i r t r a p p i n g in t h e cicatrices d u e to d e c r e a s e d elasticity o f c a d a v e r s c o u l d b e a significant s o u r c e of e r r o r , a n d e x p l a i n t h e false p o s i t i v e results. F a l s e n e g a tive findings c o u l d b e r e d u c e d b y c o n c o m i t a n t p a l p a t i o n . T h e use of a 7.5- o r 1 0 M H z t r a n s d u c e r c o u l d i m p r o v e results r e g a r d i n g f o r e i g n b o d i e s l o c a t e d s u p e r f i c i a l l y [6].
References 1. Anderson MA, Newmeyer WL, Kilgore ES (1982) Diagnosis and treatment of retained foreign bodies in the hand. Am J Surg 144 : 63 2. De Flaviis L, Scaglione P, Del Bo P, Nessi P (1988) Detection of foreign bodies in soft tissues: experimental comparison of ultrasonography and xeroradiography. J Trauma 28 : 400-404 3. Fornage BD, Schernberg FL (1987) Sonographic preoperative localization of a foreign body in the hand. J Ultrasound Med 6 : 217-219 4. Gooding GAW, Hardiman T, Sumers M, Stess R, Graf P, Grunfeld C (1987) Sonography of the hand and foot in foreign body detection. J Ultrasound Med 6 : 441-447 5. Hansson G, Beebe AC, Carroll NC, Donaldson JS (1988) A piece of wood in the hand diagnosed by ultrasonography. Acta Orthop Scand 59 : 459-460 6. Little CM, Parker MG, Callowich MC, Sartori JC (1986) The ultrasonic detection of soft tissue foreign bodies. Invest Radiot 21 : 275-277 7. Suramo I, Pamilo M (1986) Ultrasound examination of foreign bodies. Acta Radiologica 27 : 463-466 8. Von Weiss H, Leixner M, Janout D (1985) Nachweis eines intramuskul~r gelegenen HolzstiJckes mittels Sonographie. Fortschr Roentgenstr 142 : 696
Received December 15, 1989
ofOrthopaedic .dTrauma Surgery @ Springer-Verlag 1990
Ultrasonographic detection of foreign bodies in soft tissue A human cadaver study P. J. H. Blyme, T. Lind, K. Schantz, and P. Lavard Department of Orthopaedics T, Gentofte Hospital, University of Copenhagen, DK-2900 Hellerup, Denmark
Summary. T h e usefulness of ultrasound in the detection of foreign bodies was examined in a blind study in h u m a n cadavers using glass, plastic and w o o d as foreign bodies. Of 65 foreign bodies placed in 102 cicatrices, 58 were f o u n d using a 5 M H z transducer. T h e sensitivity was 89% and the specificity 93% making ultrasound a useful clinical tool for this purpose.
D e t e c t i o n of minute foreign bodies in soft tissues is a c o m m o n clinical p r o b l e m and can be difficult, especially if the foreign bodies are invisible on radiographs. P r o m ising results concerning the use of ultrasound in the detection of foreign bodies have b e e n presented in a few case histories [3, 5, 8] and in some in-vitro investigations [2, 4, 6, 7]. N o n e of these investigations, h o w e v e r , were blind or c o n d u c t e d in h u m a n soft tissue. To evaluate the clinical usefulness of the technique, we present a blind study of ultrasonographic detection of foreign bodies in h u m a n cadavers.
Methods and materials In 17 thighs from 9 human cadavers, 102 incisions were made (6 in each thigh). Foreign bodies of wood, glass or plastic were inserted randomly. Incisions without foreign bodies were cannulated with a 2 mm trochar, simulating damage to the soft tissue made by a noncaptured foreign body. A total of 65 foreign bodies were placed (glass: 14; wood: 27; plastic: 24), ranging from 3 mm to30 mm in size (Table 1). All the incisions were examined with a 5-MHz ultrasonic transducer (Picker CS 9500) and acoustic gel. The series was performed blind: one of the authors inserted the foreign bodies and another did the sonographic examination unaware of the content. Palpation of the area was not allowed during the test. Offprint requests to: Dr.P.J.H.Blyme, Violvej 26 B, DK-2820
Gentofte, Denmark
Results O f the 65 foreign bodies implanted, 58 were found, giving a sensitivity of 89% and a specificity of 93%. T h e results and confidence limits in relation to the type of foreign b o d y are shown in Table 2. T h e right diagnosis was achieved in 91 of 102 cases. T h e characteristic ultrasonographic a p p e a r a n c e of glass is shown in Fig. 1. T h e ultrasonographic appearances of plastic and w o o d are very similar and are shown in Fig. 2 and 3.
Discussion In a retrospective study [1] describing 200 cases of retained foreign bodies, the most c o m m o n materials were
Table 1. Number, size and localization in thigh of 65 foreign bodies evaluated ultra sonographically Material
n
Size (median) (mm)
Depth (mm)
Wood Plastic Glass
27 24 14
5 x 1 × 1-30 × 2 × 2 (10 × 2 x 2) 5 x 1 x 1-20 x 2 x 3 (10 × 2 x 2) 3x2×2-10×4×2 (5×3×2)
2-40 2-40 2-40
Table 2. Results of ultrasonographic of foreign bodies in human soft tissue Material
Right diagn,
Wrong diagn,
Total
Confidence limits (95%)
Wood Plastic Glass Empty
24 20 14 33
3 4 0 4
27 24 14 37
71- 98 63- 95 77-100 75- 97
Total
91
11
102
81- 94
P. J. H. Blyme et al. : US Detection of foreign bodies in human soft tissue
25
Fig.1. Glass splinter (5 x 3 × 2 mm) located at a depth of 6 ram.
Acknowledgement. We thank Dr.S0ren Hancke, Department of
Arrow, typical comet tail of echo reverberation. A, skin
Ultrasound, Gentofte Hospital, University of Copenhagen, for advice and technical assistance.
Fig. 2. Foreign body of plastic (5 × 3 × i mm) located at a depth of 8 ram. The small arrow shows a hyperechoic area corresponding to the surface of the plastic body. The large arrow shows the shadow. A, skin Fig. 3. Foreign body of wood (10 × 2 × 2 mm) located at a depth of t0 ram. The small arrow shows the foreign body, the large arrow shows shadow. A, skin
w o o d , glass a n d m e t a l . M e t a l is visible o n r a d i o g r a p h s . I. S u r a m o a n d M. P a m i l o [7] f o u n d t h a t f o r e i g n b o d i e s o f v a r i o u s m a t e r i a l s (glass, w o o d , plastic, etc.) r e f l e c t e d m o r e i n t e n s e e c h o e s (5 M H z ) t h a n t h e t r a n s m i s s i o n m e d i u m ( m i n c e d m e a t ) w h e n s i t u a t e d in f a v o u r a b l e positions, b u t t h e clinical u s e f u l n e s s was n o t e v a l u a t e d . O u r s t u d y i n d i c a t e s t h e usefulness of u l t r a s o u n d in the clinical d e t e c t i o n of f o r e i g n b o d i e s . A s s h o w n in Fig. 1, glass causes a t y p i c a l c o m e t tail o f r e v e r b e r a t i o n echoes [2], while w o o d a n d plastic p r o d u c e i d e n t i c a l h y p e r e c h o i c p a t t e r n s a n d s h a d o w s . T h e l a t t e r can b e difficult to distinguish f r o m s h a d o w s c a u s e d b y air t r a p p e d in t h e cicatrices. A i r t r a p p i n g in t h e cicatrices d u e to d e c r e a s e d elasticity o f c a d a v e r s c o u l d b e a significant s o u r c e of e r r o r , a n d e x p l a i n t h e false p o s i t i v e results. F a l s e n e g a tive findings c o u l d b e r e d u c e d b y c o n c o m i t a n t p a l p a t i o n . T h e use of a 7.5- o r 1 0 M H z t r a n s d u c e r c o u l d i m p r o v e results r e g a r d i n g f o r e i g n b o d i e s l o c a t e d s u p e r f i c i a l l y [6].
References 1. Anderson MA, Newmeyer WL, Kilgore ES (1982) Diagnosis and treatment of retained foreign bodies in the hand. Am J Surg 144 : 63 2. De Flaviis L, Scaglione P, Del Bo P, Nessi P (1988) Detection of foreign bodies in soft tissues: experimental comparison of ultrasonography and xeroradiography. J Trauma 28 : 400-404 3. Fornage BD, Schernberg FL (1987) Sonographic preoperative localization of a foreign body in the hand. J Ultrasound Med 6 : 217-219 4. Gooding GAW, Hardiman T, Sumers M, Stess R, Graf P, Grunfeld C (1987) Sonography of the hand and foot in foreign body detection. J Ultrasound Med 6 : 441-447 5. Hansson G, Beebe AC, Carroll NC, Donaldson JS (1988) A piece of wood in the hand diagnosed by ultrasonography. Acta Orthop Scand 59 : 459-460 6. Little CM, Parker MG, Callowich MC, Sartori JC (1986) The ultrasonic detection of soft tissue foreign bodies. Invest Radiot 21 : 275-277 7. Suramo I, Pamilo M (1986) Ultrasound examination of foreign bodies. Acta Radiologica 27 : 463-466 8. Von Weiss H, Leixner M, Janout D (1985) Nachweis eines intramuskul~r gelegenen HolzstiJckes mittels Sonographie. Fortschr Roentgenstr 142 : 696
Received December 15, 1989
