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Within Normal Limits

Seemingly Common Injury is Anything But

Thomas, Jenny MD; Patel, Himanshu MD; Patel, Shivani MD

doi: 10.1097/01.EEM.0000472667.00372.82
Within Normal Limits

Dr. Thomasis a fifth-year radiology resident at Westchester Medical Center in Valhalla, NY, whereDr. Himanshu Patelis the director of musculoskeletal radiology. He is also an assistant professor of radiology at New York Medical College. Dr. Shivani Patelis an emergency physician at Stamford (CT) Hospital.

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A 46-year-old woman presented with complaints of right medial ankle soft tissue swelling and a laceration following a family picnic. She has difficulty walking and cannot bear significant weight.

Radiographs of her right ankle are shown. What is her diagnosis?

This patient has a linear foreign body with surrounding soft tissue swelling or early organizing abscess formation.

Foreign bodies can be evaluated initially with routine x-rays. Several types of foreign bodies, however, are not radiopaque and may not be detected. Glass is always radiopaque on routine x-rays and is usually visible by radiography. Other radiopaque materials include most metallic objects (except aluminum), most animal bones, soil, sand, gravel, and mineral fragments. Some medications and poisons may also be radiopaque and may be easily identified with plain films. (Radiographics 2003;23[3]:731.)

Non-radiopaque materials also include some medications and food. Commonly encountered wood splinters, thorns of all plants, most aluminum objects, and most plastics, though, are not radiopaque and will not be clearly identified with routine x-rays. (Radiographics 2003;23[3]:731.) When given the appropriate clinical setting, ultrasound may be utilized for further evaluation of suspected foreign bodies. It may aid in localization of foreign bodies and assess for secondary complications. Foreign bodies typically appear hyperechogenic with posterior shadowing. (AJR AM J Roentgenol 2001;176[5]:1155.)

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About ‘Within Normal Limits’

This new column will highlight emergency medicine cases where radiology played a critical role in diagnosing patients. These challenging case-based presentations will highlight practical information for clinicians at the bedside, stressing diagnostic issues and their impact on patient care.

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