Ultrasonosraphy For Foreign Bodies in the Soft Tissue Sadiye Yolcu PII: DOI: Reference:
S0735-6757(15)00234-X doi: 10.1016/j.ajem.2015.03.060 YAJEM 54903
To appear in:
American Journal of Emergency Medicine
Received date: Revised date: Accepted date:
22 March 2015 27 March 2015 27 March 2015
Please cite this article as: Yolcu Sadiye, Ultrasonosraphy For Foreign Bodies in the Soft Tissue, American Journal of Emergency Medicine (2015), doi: 10.1016/j.ajem.2015.03.060
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Ultrasonosraphy For Foreign Bodies in the Soft Tissue
T
Running title: US for foreign bodies
RI P
Sadiye Yolcu
MA NU
SC
Bozok University Department of Emergency Medicine, Yozgat/Turkey
Corresponding Author: Sadiye Yolcu (MD) Email: [email protected]
Adress: Bozok Üniversitesi Tıp Fakültesi Acil Tıp AD Yozgat/Türkiye
ED
Tel: 00905053596731
PT
Fax: 00903542120036
CE
Author (s) declare that they have no conflict of interest.
AC
Text word count:373
ACCEPTED MANUSCRIPT To the editor, Foreign bodies in the soft tissue are a common cause of emergency service admission. Plain radiographs are usually the first form of examination used to detect foreign bodies [1-5]. In
T
cases where the object can not be detected on plain radiographs or the exact location of the
RI P
object needs to be identified, CT scans are helpful. Since CT scans are multi-planar and have high contrast, this method is the gold standard in the detection of foreign bodies [6]. Most foreign bodies are pieces of metal, wood, and glass [7].
SC
Ultrasonography (US) is a non-invasive, inexpensive, easy, and fast technique that can be used in emergency departments. However, knowledge regarding the use of US for soft tissue
MA NU
foreign bodies is limited. Mainly, case reports, case series, and experimental studies have been reported [8-10].
Javadrashid et al compared the usefulness of four imaging modalities in visualizing various foreign bodies of different sizes. In this study, all foreign bodies except wood were visualized best using CT. Wood could only be detected using US, and, then, only when fragments were
ED
>0.5 mm in size. Plain radiography and CT were almost equally accurate in visualizing metal
PT
and graphite and MRI was the least useful imaging technique [11]. Foreign bodies of the eyelid are one of the common reasons for emergency admissions.
CE
Removal of these foreign bodies is sometimes difficult. Some cases have been reported of the use of US for the removal of foreign bodies from the eyelid [9,10,12]. US has also been used
AC
for the removal of fish bones from tongues and esophagi [13-15], foreign bodies from children’s extremities [16,17], and for radiolucent foreign bodies in children’s stomachs [18]. Tahmasebi et al used US as a guide for soft tissue foreign bodies in fifty-one patients during one year. According to their results 47 patients had foreign bodies (31, 12, 3, and 1 case had thorn, wood, glass, and plastic, respectively). USs were positive in 50 patients. USG falsely predicted the presence of foreign bodies in four cases; there was one false negative cases. Accuracy, sensitivity, and positive predictive value of US were determined as 90.2%, 97.9%, and 92%, respectively [19]. In conclusion, further human studies are needed for the diagnosis and removal of foreign bodies from soft tissue in the emergency department.
ACCEPTED MANUSCRIPT REFERENCES 1. Stockmann P, Vairaktaris E, Fenner M, Tudor C, Neukam F, Nkenke E. Conventional radiographs: are they still the standard in localization of projectiles. Oral Surg Oral
T
Med Oral Pathol Oral Radiol Endod 2005;104:e71-5.
RI P
2. Martins WD, Fávaro DM, Westphalen FH. Emergency maxillofacial radiology. Foreign body localization: report of cases. Dentomaxillofac Radiol 2005;34:189-92. 3. Santos Tde S, Melo AR, de Moraes HH, Avelar RL, Becker OE, Haas OL Jr, et al.
Craniofac Surg 2011;22:1404-8.
SC
Impacted foreign bodies in the maxillofacial region-diagnosis and treatment. J
MA NU
4. De Santana Santos T, Avelar RL, Melo AR, de Moraes HH, Dourado E. Current approach in the management of patients with foreign bodies in the maxillofacial region. J Oral Maxillofac Surg 2011;69:2376-82.
5. Orlinsky M, Knittel P, Feit T, Chan L, Mandavia D. The comparative accuracy of radiolucent foreign body detection using ultrasonography. Am J Emerg Med
ED
2000;18:401-3.
6. Holmes PJ, Miller JR, Gutta R, Louis PJ. Intraoperative imaging techniques: a guide
2005;100:614-8.
Aras MH, Miloglu O, Barutcugil C, Kantarci M, Ozcan E, Harorli A. Camparison of
CE
7.
PT
to retrieval of foreign bodies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
the sensitivity for detecting foreign bodies among conventional plain radiography,
8.
AC
computed tomography and ultrasonography. Dentomaxillofac Radiol 2010;39:72-8. Smith ME, Riffat F, Berman LH, Jani P. Intraoperative ultrasound to facilitate removal of a submucosal foreign body. J Clin Ultrasound. 2014 Nov-Dec;42(9):565-8. doi: 10.1002/jcu.22226. Epub 2014 Aug 22. 9.
Pokhraj P S, Jigar J P, Mehta C, Narottam A P. Intraocular metallic foreign body: role of computed tomography. J Clin Diagn Res. 2014 Dec;8(12):RD01-3. doi: 10.7860/JCDR/2014/9949.5271. Epub 2014 Dec 5
10. Costa MA, Garcia PN, Barroso LF, Ferreira MA, Okuda ÉA, Allemann N. Composition of intraocular foreign bodies: experimental study of ultrasonographic presentation. Arq Bras Oftalmol. 2013 Jan-Feb;76(1):13-7. 11. Javadrashid R, Fouladi DF, Golamian M, Hajalioghli P, Daghighi MH, Shahmorady Z, Niknejad MT. Visibility of different foreign bodies in the maxillofacial region
ACCEPTED MANUSCRIPT using plain radiography, CT, MRI and ultrasonography: an in vitro study. Dentomaxillofac Radiol. 2014 Dec 18:20140229. 12. Yoo SH, Rootman DB, Goh A, Savar A, Goldberg RA. Localization and Retrieval of
T
an Eyelid Metallic Foreign Body With an Oscillating Magnet and High-Resolution
RI P
Ultrasonography. Ophthal Plast Reconstr Surg. 2014 Aug 26.
13. Smith ME, Riffat F, Berman LH, Jani P. Intraoperative ultrasound to facilitate
doi: 10.1002/jcu.22226. Epub 2014 Aug 22.
SC
removal of a submucosal foreign body. J Clin Ultrasound. 2014 Nov-Dec;42(9):565-8.
14. Baba S, Takizawa K, Yamada C, Monobe H. A submucosal esophageal fish bone
MA NU
foreign body surgically removed using intraoperative ultrasonography. Am J Otolaryngol. 2014 Mar-Apr;35(2):268-70. doi: 10.1016/j.amjoto.2013.10.006. Epub 2013 Oct 30.
15. Salmon M, Doniger SJ. Ingested foreign bodies: a case series demonstrating a novel application of point-of-care ultrasonography in children. Pediatr Emerg Care. 2013
ED
Jul;29(7):870-3. doi: 10.1097/PEC.0b013e3182999ba3. 16. Nwawka OK, Kabutey NK, Locke CM, Castro-Aragon I, Kim D.Ultrasound-guided
PT
needle localization to aid foreign body removal in pediatric patients. J Foot Ankle Surg. 2014 Jan-Feb;53(1):67-70. doi: 10.1053/j.jfas.2013.09.006. Epub 2013 Nov 13.
CE
17. Borgohain B, Borgohain N, Handique A, Gogoi PJ. Case report and brief review of literature on sonographic detection of accidentally implanted wooden foreign body causing persistent sinus. Crit Ultrasound J. 2012 May 16;4(1):10. doi: 10.1186/2036-
AC
7902-4-10
18. Jecković M, Anupindi SA, Barbir SB, Lovrenski J. Is ultrasound useful in detection and follow-up of gastric foreign bodies in children? Clin Imaging. 2013 NovDec;37(6):1043-7. 19. Tahmasebi M, Zareizadeh H, Motamedfar A. Accuracy of ultrasonography in detecting radiolucent soft-tissue foreign bodies. Indian J Radiol Imaging. 2014 Apr;24(2):196-200.
S0735-6757(15)00234-X doi: 10.1016/j.ajem.2015.03.060 YAJEM 54903
To appear in:
American Journal of Emergency Medicine
Received date: Revised date: Accepted date:
22 March 2015 27 March 2015 27 March 2015
Please cite this article as: Yolcu Sadiye, Ultrasonosraphy For Foreign Bodies in the Soft Tissue, American Journal of Emergency Medicine (2015), doi: 10.1016/j.ajem.2015.03.060
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Ultrasonosraphy For Foreign Bodies in the Soft Tissue
T
Running title: US for foreign bodies
RI P
Sadiye Yolcu
MA NU
SC
Bozok University Department of Emergency Medicine, Yozgat/Turkey
Corresponding Author: Sadiye Yolcu (MD) Email: [email protected]
Adress: Bozok Üniversitesi Tıp Fakültesi Acil Tıp AD Yozgat/Türkiye
ED
Tel: 00905053596731
PT
Fax: 00903542120036
CE
Author (s) declare that they have no conflict of interest.
AC
Text word count:373
ACCEPTED MANUSCRIPT To the editor, Foreign bodies in the soft tissue are a common cause of emergency service admission. Plain radiographs are usually the first form of examination used to detect foreign bodies [1-5]. In
T
cases where the object can not be detected on plain radiographs or the exact location of the
RI P
object needs to be identified, CT scans are helpful. Since CT scans are multi-planar and have high contrast, this method is the gold standard in the detection of foreign bodies [6]. Most foreign bodies are pieces of metal, wood, and glass [7].
SC
Ultrasonography (US) is a non-invasive, inexpensive, easy, and fast technique that can be used in emergency departments. However, knowledge regarding the use of US for soft tissue
MA NU
foreign bodies is limited. Mainly, case reports, case series, and experimental studies have been reported [8-10].
Javadrashid et al compared the usefulness of four imaging modalities in visualizing various foreign bodies of different sizes. In this study, all foreign bodies except wood were visualized best using CT. Wood could only be detected using US, and, then, only when fragments were
ED
>0.5 mm in size. Plain radiography and CT were almost equally accurate in visualizing metal
PT
and graphite and MRI was the least useful imaging technique [11]. Foreign bodies of the eyelid are one of the common reasons for emergency admissions.
CE
Removal of these foreign bodies is sometimes difficult. Some cases have been reported of the use of US for the removal of foreign bodies from the eyelid [9,10,12]. US has also been used
AC
for the removal of fish bones from tongues and esophagi [13-15], foreign bodies from children’s extremities [16,17], and for radiolucent foreign bodies in children’s stomachs [18]. Tahmasebi et al used US as a guide for soft tissue foreign bodies in fifty-one patients during one year. According to their results 47 patients had foreign bodies (31, 12, 3, and 1 case had thorn, wood, glass, and plastic, respectively). USs were positive in 50 patients. USG falsely predicted the presence of foreign bodies in four cases; there was one false negative cases. Accuracy, sensitivity, and positive predictive value of US were determined as 90.2%, 97.9%, and 92%, respectively [19]. In conclusion, further human studies are needed for the diagnosis and removal of foreign bodies from soft tissue in the emergency department.
ACCEPTED MANUSCRIPT REFERENCES 1. Stockmann P, Vairaktaris E, Fenner M, Tudor C, Neukam F, Nkenke E. Conventional radiographs: are they still the standard in localization of projectiles. Oral Surg Oral
T
Med Oral Pathol Oral Radiol Endod 2005;104:e71-5.
RI P
2. Martins WD, Fávaro DM, Westphalen FH. Emergency maxillofacial radiology. Foreign body localization: report of cases. Dentomaxillofac Radiol 2005;34:189-92. 3. Santos Tde S, Melo AR, de Moraes HH, Avelar RL, Becker OE, Haas OL Jr, et al.
Craniofac Surg 2011;22:1404-8.
SC
Impacted foreign bodies in the maxillofacial region-diagnosis and treatment. J
MA NU
4. De Santana Santos T, Avelar RL, Melo AR, de Moraes HH, Dourado E. Current approach in the management of patients with foreign bodies in the maxillofacial region. J Oral Maxillofac Surg 2011;69:2376-82.
5. Orlinsky M, Knittel P, Feit T, Chan L, Mandavia D. The comparative accuracy of radiolucent foreign body detection using ultrasonography. Am J Emerg Med
ED
2000;18:401-3.
6. Holmes PJ, Miller JR, Gutta R, Louis PJ. Intraoperative imaging techniques: a guide
2005;100:614-8.
Aras MH, Miloglu O, Barutcugil C, Kantarci M, Ozcan E, Harorli A. Camparison of
CE
7.
PT
to retrieval of foreign bodies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
the sensitivity for detecting foreign bodies among conventional plain radiography,
8.
AC
computed tomography and ultrasonography. Dentomaxillofac Radiol 2010;39:72-8. Smith ME, Riffat F, Berman LH, Jani P. Intraoperative ultrasound to facilitate removal of a submucosal foreign body. J Clin Ultrasound. 2014 Nov-Dec;42(9):565-8. doi: 10.1002/jcu.22226. Epub 2014 Aug 22. 9.
Pokhraj P S, Jigar J P, Mehta C, Narottam A P. Intraocular metallic foreign body: role of computed tomography. J Clin Diagn Res. 2014 Dec;8(12):RD01-3. doi: 10.7860/JCDR/2014/9949.5271. Epub 2014 Dec 5
10. Costa MA, Garcia PN, Barroso LF, Ferreira MA, Okuda ÉA, Allemann N. Composition of intraocular foreign bodies: experimental study of ultrasonographic presentation. Arq Bras Oftalmol. 2013 Jan-Feb;76(1):13-7. 11. Javadrashid R, Fouladi DF, Golamian M, Hajalioghli P, Daghighi MH, Shahmorady Z, Niknejad MT. Visibility of different foreign bodies in the maxillofacial region
ACCEPTED MANUSCRIPT using plain radiography, CT, MRI and ultrasonography: an in vitro study. Dentomaxillofac Radiol. 2014 Dec 18:20140229. 12. Yoo SH, Rootman DB, Goh A, Savar A, Goldberg RA. Localization and Retrieval of
T
an Eyelid Metallic Foreign Body With an Oscillating Magnet and High-Resolution
RI P
Ultrasonography. Ophthal Plast Reconstr Surg. 2014 Aug 26.
13. Smith ME, Riffat F, Berman LH, Jani P. Intraoperative ultrasound to facilitate
doi: 10.1002/jcu.22226. Epub 2014 Aug 22.
SC
removal of a submucosal foreign body. J Clin Ultrasound. 2014 Nov-Dec;42(9):565-8.
14. Baba S, Takizawa K, Yamada C, Monobe H. A submucosal esophageal fish bone
MA NU
foreign body surgically removed using intraoperative ultrasonography. Am J Otolaryngol. 2014 Mar-Apr;35(2):268-70. doi: 10.1016/j.amjoto.2013.10.006. Epub 2013 Oct 30.
15. Salmon M, Doniger SJ. Ingested foreign bodies: a case series demonstrating a novel application of point-of-care ultrasonography in children. Pediatr Emerg Care. 2013
ED
Jul;29(7):870-3. doi: 10.1097/PEC.0b013e3182999ba3. 16. Nwawka OK, Kabutey NK, Locke CM, Castro-Aragon I, Kim D.Ultrasound-guided
PT
needle localization to aid foreign body removal in pediatric patients. J Foot Ankle Surg. 2014 Jan-Feb;53(1):67-70. doi: 10.1053/j.jfas.2013.09.006. Epub 2013 Nov 13.
CE
17. Borgohain B, Borgohain N, Handique A, Gogoi PJ. Case report and brief review of literature on sonographic detection of accidentally implanted wooden foreign body causing persistent sinus. Crit Ultrasound J. 2012 May 16;4(1):10. doi: 10.1186/2036-
AC
7902-4-10
18. Jecković M, Anupindi SA, Barbir SB, Lovrenski J. Is ultrasound useful in detection and follow-up of gastric foreign bodies in children? Clin Imaging. 2013 NovDec;37(6):1043-7. 19. Tahmasebi M, Zareizadeh H, Motamedfar A. Accuracy of ultrasonography in detecting radiolucent soft-tissue foreign bodies. Indian J Radiol Imaging. 2014 Apr;24(2):196-200.
