Kartiko Michael, Guduru Mounika, Denotter Tami, Villada Fabio
Creighton University School of Medicine Department of Radiology, 7710 Mercy Rd. Suite 502, Omaha, NE 68124, United States of America.
Trauma Case Rep. 2021 Aug 3;35:100514. doi: 10.1016/j.tcr.2021.100514. eCollection 2021 Oct.
The investigation of embedded soft tissue foreign bodies relies heavily on radiological imaging. The prompt identification of these objects is critical as retained foreign bodies may lead to serious infection or chronic debilitating pain depending on anatomical location. In this report, we present a case of a radiographically occult traumatically implanted foreign body in a 15-year-old female after a high-speed motor vehicle accident. Initial computed tomography (CT) scan was unremarkable and exploration under anesthesia demonstrated no other significant findings, yet the patient continued to suffer severe refractory radicular pain with marked limitation of daily function. It was not until 12 weeks after the accident that a magnetic resonance image (MRI) of the pelvis revealed a deep sinus tract with central low magnetic resonance (MR) signal, raising suspicion for a retained foreign body. A 10-centimeter plastic foreign body extending from the patient's coccyx to the sciatic foramen was identified and surgically removed resulting in immediate symptom relief. This case illustrates that the detection of a retained foreign body is not always straightforward and multiple imaging modalities may be necessary for accurate diagnosis. We also discuss the most appropriate diagnostic imaging algorithm when a foreign body of the musculoskeletal system is suspected.
对嵌入软组织的异物进行检查在很大程度上依赖于放射成像。及时识别这些异物至关重要，因为根据异物所在的解剖位置，留存的异物可能会导致严重感染或慢性使人衰弱的疼痛。在本报告中，我们呈现了一例15岁女性在高速机动车事故后影像学检查隐匿的创伤性植入异物的病例。最初的计算机断层扫描（CT）未发现异常，麻醉下探查也未发现其他显著异常，但患者仍持续遭受严重的顽固性神经根性疼痛，日常功能明显受限。直到事故发生12周后，骨盆的磁共振成像（MRI）显示出一条深部窦道，其中心磁共振（MR）信号较低，这引发了对留存异物的怀疑。随后发现并手术取出了一个从患者尾骨延伸至坐骨孔的10厘米长的塑料异物，患者症状立即缓解。该病例表明，留存异物的检测并非总是简单直接的，可能需要多种成像方式才能准确诊断。我们还讨论了怀疑存在肌肉骨骼系统异物时最合适的诊断成像算法。
