Foreign bodies in hand

Foreign body in hand
Foreign body in hand on sonography
symptom of foreign body
foreign body granuloma
Epidermoid cyst
Epidermoid cyst on X-ray
Epidermoid cyst on X-ray
Epidermoid cyst on X-ray
Epidermoid cyst on ultrasonography
Epidermoid cyst on ultrasonography
Foreign body on ultrasonography
Foreign body on MRI and CT
Foreign body in hand




 Foreign bodies in hand

Common presentation at ER room

May remain asymptomatic for prolonged periods of time

Formation of foreign body granulomas, pyogenic granulomas, abscess




Foreign bodies in hand

Common presentation at ER room

May remain asymptomatic for prolonged periods of time

Formation of foreign body granulomas, pyogenic granulomas, abscess




Localized pain 

Foreign body granuloma

presence of the foreign body changes the healing response

protein adsorption, macrophages, multinucleated foreign body giant cells (macrophage fusion), fibroblasts, and angiogenesis

Epidermoid cyst

painless, benign, slow-growing soft tissue tumor

occurs months to years after a traumatic event


penetrating injury 

→ keratinizing epithelium into subcutaneous tissues 

→ produce an epithelial cell-lined cyst filled with keratin

X-ray

38% of retained foreign bodies were overlooked 


Unlike metal objects, glass and wood can be radiolucent

Less than 15% wooden foreign bodies are detected with radiography

approximately 50% glass is missed 


soft tissue - less radiation and less contrast in an X-ray image







X-ray

Conventional transmission X-ray  

  : decrease of the X-ray beam‘s 

    intensity (attenuation)



Dark field X-ray

  : scattering due to the porous 

    microstructure of the sample



Phase contrast X-ray

  : changes in the phase of an X-ray



X-ray

Conventional transmission X-ray  

  : decrease of the X-ray beam‘s 

    intensity (attenuation)



Dark field X-ray

  : scattering due to the porous 

    microstructure of the sample



Phase contrast X-ray

  : changes in the phase of an X-ray



Ultrasonography (US)

Echogenicity of the Foreign Body : all echogenic


Posterior Shadowing and Reverberation(잔향 or 반향)

surface attributes rather than its composition








Ultrasonography (US)

Surrounding Hypoechoic Rim

longer than about 24 hours, the ensuing inflammatory reaction 




Localization 

Examination muscle, tendon, ligaments, neurovascular



Ultrasonography (US)

Associated Soft-Tissue Complications

MRI and CT

Provide additional information 


location and relationship of FB

neurovascular bundles, and muscle groups 


guide in selection of surgical approach and extent of exploration

Summary

Appropriate imaging modality

X-ray (Dark field, phase contrast)  soft tissue tech.

U/S

MRI, CT etc


Associated condition 

Localized pain, epidemoid cyst, granulomas, tenosynovitis, abscess


accurate localization followed by surgical exploration and removal


Popular posts from this blog

Mirels’ Classification for pathologic fractures

Image
 Mirels’Classification Mirels H: Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop 249:256–264, 1989. Mirels’Classification : Nature of lesion Mirels’Classification : Nature of lesion Orthopedic Radiology: A Practical Approach, Greenspan, Adam; Lippincott, 2000 Diagnosis of Bone and Joint Disorders, Resnick, Donald, W. B. Saunders Mirels’Classification : Nature of lesion Score of 8 or higher  consider prophylactic internal fixation Guideline aids in decision making, but does not serve as an absolute criterion Each patient should be evaluated individually, keeping two generally accepted principles in mind.  First, prophylactic internal fixation of an impending fracture is technically easier than fixation of an actual pathologic fracture. Second, patient morbidity is decreased with prophylactic fixation compared with fixation after the fracture. Prophylactic intramedullary fixation (↓pain and prevent subsequen...
Read more

Tibial spine fracture

Image
  Tibial spine fracture HyperExtension and femur external rotation during a fall Intercondyle eminence : Medial spine (ACL attachment) + Lateral spine ACL fiber -> tibial spine, inter-meniscal lig, MM attachment Classification Modified Meyers and McKeever classification Non-Operative management Type I, II (after C/R) Long leg cast, Slightly flexion (avoid ACL positional tension) Hemarthrosis evacuation Closed reduction (Physician’s preference for Type II) Surgical treatment Type II & III & IV Reduction method : Arthroscopic vs Open Fixation method : Suture vs Screw
Read more

Adrena incidentaloma: Diagnosis & Treatments

Epidemiology Adrenal incidentaloma is an adrenal mass lesion with a diameter of more than 1 cm incidentally detected by imaging. Adrenal incidentaloma is found in at least 2% of the population, and the prevalence increases with age. Adrenal incidentaolma is found in 1% of 40s and 7% of 70s. Most adrenal incidentalomas are endocrine-inactive adrenocortical adenomas that do not release hormones. The prevalence of endocrine-inactive adrenocortical adenoma is 60 to 85% of endocrine-active adrenocortical adenoma, endocrine-active adrenocortical adenoma is 5 to 10% of cortisol producing adenoma, aldosterone-producing adenoma is 2 to 5%, and pheochromocytoma is 5 to 10 %. 2 to 5% of the unilateral adrenal mass is a malignant adrenocortical carcinoma and 15% is metastatic cancer at other sites. Diagnosis Diagnostic evaluation should be performed in patients with adrenal masses greater than 1 cm. Two important factors must be considered. First, does the tumor secrete hormones that can harm...
Read more