Shiels W E, Babcock D S, Wilson J L, Burch R A
Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH.
AJR Am J Roentgenol. 1990 Dec;155(6):1277-81. doi: 10.2214/ajr.155.6.2122680.
Sonography was used to detect, localize, and guide removal of foreign bodies in the soft tissues of the extremities and neck. Twenty localization procedures were performed in 19 patients (12 children and seven adults) with 21 foreign bodies including wood, glass, stone, metal, and lead pencil. Localization was accomplished by using anatomic landmarks, ink marks on the skin, and needle and hemostat markers. Localization was facilitated by the use of small standoff pads that were cut for use on small surfaces. The foreign bodies were visualized as hyperechoic foci with acoustic shadows that were partial or complete depending on the angle of insonation and foreign body composition. Hyperechoic comet-tail artifacts (reverberation artifacts) were seen with six metallic foreign bodies and one glass fragment. Nine foreign bodies were surrounded by hypoechoic halos caused by edema, abscess, or granulation tissue. A slow meticulous scanning technique and high-frequency transducer helped in detection of small foreign bodies. Sonographically guided removal of the foreign body was successful in all four patients in whom it was attempted. Scanning with the ultrasound beam parallel to the long axis of the hemostat and the foreign body was the fastest way to guide the hemostat to the tip of a foreign body. The procedure was accomplished most easily and quickly when one physician performed sonography and hemostat removal of the foreign body simultaneously. Our experience with these cases indicates that sonography is a useful tool in the localization and removal of soft-tissue foreign bodies.
超声检查用于检测、定位并引导取出四肢和颈部软组织中的异物。对19例患者（12名儿童和7名成人）进行了20次定位操作，共取出21个异物，包括木头、玻璃、石头、金属和铅笔芯。通过使用解剖标志、皮肤上的墨水标记以及针和止血钳标记来完成定位。使用为小表面切割的小型隔离垫有助于定位。异物表现为高回声灶，伴有声影，声影根据入射角度和异物成分可部分或完全出现。6个金属异物和1个玻璃碎片可见高回声彗尾伪像（混响伪像）。9个异物被由水肿、脓肿或肉芽组织引起的低回声晕圈包围。缓慢细致的扫描技术和高频探头有助于检测小的异物。在尝试进行超声引导下异物取出的所有4例患者中均获成功。使超声束与止血钳和异物的长轴平行进行扫描是将止血钳引导至异物尖端的最快方法。当一名医生同时进行超声检查和用止血钳取出异物时，该操作最容易且迅速完成。我们对这些病例的经验表明，超声检查是定位和取出软组织异物的有用工具。
