Radiology Resident Case of the Week
Clinical Sx:
Etiology/Pathophysiology
This case nicely demostrates the
proverbial "thorn in one's side" which must have occured during the
patient's chase through low-lying brush. The heat of the moment and
adrenaline rush prevented the patient from feeling any pain or injury
during the event, and the problem became manifest only after the
juveline deliquents were in custody.
Pathology:
Miscellaneous
Unless plain films are optimized for soft tissue
imaging, a small foreign body made of wood can be easily missed.
Imaging
The sonographic calf evaluation shows an echogenic
tubular structure with acoustic shadowing in a focal area of pain.
The structure is imbedded diagonally deep within the calf muscles,
but is not surrounded by fluid collections to suggest a hematoma or
abscess.
DDX
Imbedded foreign body.
The patient underwent a limited fasciotomy and a 6
cm thorn was removed without complications. The patient made a full
recovery on a short course of antibiotics.
From the clinical presentation, the differential diagnosis in this case included cellulitis, soft tissue hematoma, deep venous thrombosis and foreign body.
Key references
ACR Code
Keywords: