2004 Texas Radiological Society UNKNOWN CASES Ultrasound

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
2002178557-562.
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
2002178557-562.
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