Large wooden foreign body in the hand: recognition of occult fragments with ultrasound

Abstract

A 37-year-old man with pain and swelling of the thenar was referred to the emergency department. On ultrasound a 3 x 1 x 0.2 cm large wooden foreign body was depicted in the thenar region. In addition, ultrasonography (US) was able to show multiple smaller fragments adjacent to the larger foreign body. To give a better overview of the position relative to tendons and muscles, CT with soft tissue window settings was performed. CT gave a good anatomic overview but was not able to show the smaller fragments. A total of six additional fragments were depicted at US. Performing US is mandatory in patients with penetrating injuries by foreign bodies because it is very sensitive. Using US in an emergency setting can avoid retained fragments and depict other soft tissue complications.