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2004 Texas Radiological Society UNKNOWN CASES Ultrasound

2004 Texas Radiological Society UNKNOWN CASES Ultrasound Justin Q. Ly, MD Douglas P. Beall, MD Wilford Hall Medical Center San Antonio, TX ULTRASOUND 32-year-old male Remote penetrating trauma to thigh while trying to climb over wooden fence

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2004 Texas Radiological Society UNKNOWN CASES Ultrasound

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  1. 2004 Texas Radiological SocietyUNKNOWN CASESUltrasound Justin Q. Ly, MD Douglas P. Beall, MD Wilford Hall Medical Center San Antonio, TX

  2. ULTRASOUND • 32-year-old male • Remote penetrating trauma to thigh while trying to climb over wooden fence • Asymptomatic x 20 years, then developed fluctuant mass in region of prior trauma

  3. Courtesy Peterson JJ

  4. Courtesy Peterson JJ

  5. Courtesy Peterson JJ

  6. Courtesy Peterson JJ

  7. Courtesy Peterson JJ

  8. 2004 Texas Radiological SocietyDiagnosis forUltrasound Case Justin Q. Ly, MD Douglas P. Beall, MD Wilford Hall Medical Center San Antonio, TX

  9. REVIEW OF IMAGING FINDINGS • XR negative • MR • fluid collection with thick enhancing rind c/w abscess. Distinct retained wooden foreign body not seen. • US • hyperechoic linear cylindrical structure with marked acoustic shadowing indicative of retained wooden foreign body

  10. Diagnosis Debridement of abscess and retained wood found to be encapsulated in dense fibrous granulomatous tissue, indicative of chronic FB reaction to wood

  11. Wooden Foreign Body/Abscess • Radiography not reliable in demonstrating wooden fbs, often unremarkable • MR-difficult to see FB when small; most: low signal with surround hi SI (inflammation/granul tissue) • CT-retained wooden FB = cylindrical foci of increased attenuation • US may be most useful modality-wood highly echogenic and revealed pronounced acoustic shadowing Peterson JJ, Bancroft LW, Kransdorf MJ. Wooden foreign bodies: imaging appearance. AJR 2002;178:557-562.

  12. Wooden Foreign Body/Abscess • Detection of wood important as it may serve as unrecognized nidus for infxn • Porous consistency and organic nature-excellent medium for microorganisms • Can result in abscess, cellulitis/osteo, fistula, synovitis when jt violated Peterson JJ, Bancroft LW, Kransdorf MJ. Wooden foreign bodies: imaging appearance. AJR 2002;178:557-562.

  13. 2004 Texas Radiological SocietyUNKNOWN CASES Justin Q. Ly, MD Douglas P. Beall, MD Wilford Hall Medical Center San Antonio, TX Click here to return to case list

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