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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

2004 Texas Radiological SocietyUNKNOWN CASESUltrasound

Justin Q. Ly, MD

Douglas P. Beall, MD

Wilford Hall Medical Center

San Antonio, TX

ultrasound
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
2004 texas radiological society diagnosis for ultrasound case

2004 Texas Radiological SocietyDiagnosis forUltrasound Case

Justin Q. Ly, MD

Douglas P. Beall, MD

Wilford Hall Medical Center

San Antonio, TX

review of imaging findings
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
diagnosis
Diagnosis

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

wooden foreign body abscess
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.

wooden foreign body abscess12
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.

2004 texas radiological society unknown cases

2004 Texas Radiological SocietyUNKNOWN CASES

Justin Q. Ly, MD

Douglas P. Beall, MD

Wilford Hall Medical Center

San Antonio, TX

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