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Kaplan AJ, Sheldon RR. Handheld Magnetometer-Assisted Localization and Removal of a Foreign Body From the Chest Wall. Mil Med 2024; 189:e420-e423. [PMID: 37470315 DOI: 10.1093/milmed/usad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
Foreign bodies fully embedded in soft tissues present a unique challenge to surgeons attempting excision. Small fragments can be nonpalpable, and many prove difficult to visualize intra-operatively by means of classic radiologic techniques. A 35-year-old active duty soldier presented requesting excision of ballistic fragment embedded in his chest wall that had previously failed a previous attempt at removal. The metallic foreign body was successfully localized intra-operatively using a handheld magnetometer probe and removed without complication. This case demonstrates the utility and cost-effectiveness of the handheld magnetometry for intra-operative localization of metallic foreign bodies. Metallic foreign bodies may be localized intra-operatively using inexpensive and reusable equipment that does not require radiation or bulky radiographic imaging equipment.
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Affiliation(s)
| | - Rowan R Sheldon
- Department of Surgery, Womack Army Medical Center, Fort Liberty, NC 28310, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA
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Black K, Wright GA, Birkholtz C, Dollar B, Hofkamp MP. Diagnosis and Management of a Retained Local Anesthetic Needle Fragment in a Patient Who Underwent Scheduled Elective Cesarean Delivery: A Case Report. A A Pract 2021; 15:e01538. [PMID: 34695036 DOI: 10.1213/XAA.0000000000001538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cesarean deliveries are often performed with a neuraxial anesthetic technique. Fracture of needles used for local anesthetic infiltration is rare. During subcutaneous infiltration of local anesthetic for a combined spinal epidural (CSE) anesthetic technique performed for elective cesarean delivery, a fragment from a fractured 27-gauge local anesthetic needle was retained in the lumbar subcutaneous tissue. CSE anesthesia was then successfully performed at a different spinal interspace, and the patient had an uneventful cesarean delivery. The patient had the needle fragment removed on the first postoperative day by an interventional radiologist who used fluoroscopy to identify the needle location.
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Carneiro BC, Cruz IAN, Chemin RN, Rizzetto TA, Guimarães JB, Silva FD, Junior CY, Pastore D, Ormond Filho AG, Nico MAC. Multimodality Imaging of Foreign Bodies: New Insights into Old Challenges. Radiographics 2021; 40:1965-1986. [PMID: 33136481 DOI: 10.1148/rg.2020200061] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Traumatic wounds and lacerations are a common reason for patients to present to emergency departments, with retained foreign bodies (FBs) accounting for 7%-15% of cases, particularly those involving the extremities. These retained materials result in a granulomatous tissue response known as an FB reaction, a pathologic attempt to isolate the FB from the host. The most common FB materials are glass, metal, and wood, but other compositions can also be found, such as plastic and animal-derived materials. Clinical history, physical examination, and wound exploration are essential in investigation of retained material but are not sufficient to exclude an FB, and additional investigation is required. Imaging evaluation is a useful tool to help depict and locate an FB, assess possible complications, and guide removal. Conventional radiography, the first-line method in this scenario, is a widely available low-cost depiction method that has good sensitivity for depicting FBs. If the retained material is not depicted at conventional radiography, US can be performed. US is highly sensitive in depicting both radiolucent and radiopaque FBs in superficial locations. For deeper objects, CT may be necessary. MRI is the best imaging modality to delineate local soft-tissue and osseous complications. Retained FBs can result in early and delayed complications, with infection being the most frequent complication. To avoid preventable morbidities related to FBs, radiologists should be familiar with imaging findings and provide essential information to help the attending physician treat each patient. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Bruno C Carneiro
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Isabela A N Cruz
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Renan N Chemin
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Thiago A Rizzetto
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Júlio B Guimarães
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Flávio D Silva
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Ciro Yoshida Junior
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Daniel Pastore
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Alípio G Ormond Filho
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Marcelo A C Nico
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
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