玻璃体内异物的超声诊断价值的探讨

目的：通过对玻璃体内异物的不同影像学检查方法(超声、CT断层、X线平片)的结果与手术结果对比,明确超声检查是与临床诊断符合率最高的影像学检查方法。方法：对137例进行过玻璃体内异物取出术患作术前超声、CT、X线报告分析。结果：超声诊断玻璃体内异物127例,检出率为92．6％,明显高于CT组(检出率为29．2％)和x线组(检出率为25．5％)。结论：通过对比,提示超声检查是临床对疑诊为玻璃体内异物患的首选影像学检查方法。     

软组织异物的超声诊断价值

1998年 2月至 2 0 0 1年 12月 ,应用高频超声诊断软组织异物 33例。超声对软组织异物图像显示清晰 ,定位准确。图 1　手部玻璃异物 (多点位 ) ;图 2　小腿部草木异物　　资料与方法33例软组织异物患者 ,男性 2 7例 ,女性 6例 ,年龄 13～ 5 2岁 ,平均 35 .6岁。软组织玻璃异物 2 5例 ,其中足底玻璃异物18例 ,手部玻璃异物 7例 ;草木异物 7例 ,其中臀部草木异物 2例 ,小腿部草木异物 5例 ;塑料异物 1例 ,位于手掌大鱼际处。32例患者来诊时为闭合性损伤 ,1例手掌塑料异物患者伤口久不愈合 ,为开放性损伤。患者均有外伤史 ,患处有不同程度的疼痛…     

超声诊断软组织内异物1例

患者男,27岁。于2周前睡觉翻身时瞬间突感左膝部针扎样疼痛,当时检查无明显异常,行走、运动均无障碍。近日左膝外侧出现硬结,触之有痛感。体检皮肤无明显伤口。超声检查:左膝外侧距体表 0.5 cm 处,自皮下至肌层可见一斜置的3.5 cm×0.1 cm 的带状强回声,后方呈“彗星尾征”,近端粗于远端(图1)。超声提示:左膝外侧软组织异物(缝衣针)。经手术证实。讨论　体内异物并不少见,该患者体表无明显伤口,异物所在位置距第一痛点相距 5.0 cm,说明异物在体内移动,如不及时发现可对人体造成更大伤害。超声检查能迅速、快捷、无创地准确定位,为诊断…     

超声X线联合诊断金属异物二例

2007年8月我维和医疗分队赴非洲利比里亚任务区展开：二级医院工作，存条件艰苦，医疗资源有限的情况下，利用超声X线联合检查，诊断联合圉维和人员左膝关节及肝右叶包膜边缘处金属异物2例：现报道如下。     

超声诊断甲状腺内鱼刺异物1例

鱼刺异物上消化道异物中最常见的异物之一,常停留在腭扁桃体、会厌谿、梨状窝、食管等处,其穿透食管壁进入甲状腺者,比较少见。鱼刺异物损伤消化道以及颈部甲状腺组织,形成穿通伤,没有损伤颈部大的血管以及神经者更是罕见。现将我院收治的此类颈部异物损伤典型病例报告如下。     

创伤性软组织内玻璃异物的X线检查方法

目的 探讨创伤性软组织内玻璃异物的X线检查方法。方法 选取创伤所致软组织内玻璃异物病例12例，均摄骨条件X线平片后复查软组织条件X线平片。结果 骨条件常规X线正侧位片均未发现阳性异物影，软组织X线平片发一现异物。结论 软组织X线平片可使创伤性软组织内玻璃异物显影，可做为辅助临床明确诊断的一种方法。     

眼科脉冲电磁吸铁器在软组织金属异物取出中的应用

对软组织金属异物定位，文献报道各异，如二维定位、三维定位，手术操作包括套管吸取、磁性吸引等方法。异物取出一般是先用X线拍片定位以后切开软组织寻找，由于金属异物可以随着肌肉的收缩而改变位置，导致金属异物在体内游走，在取异物时定位的位置往往发生改变，致使异物取出困难，往往需要在X线透视下取出，病人和医护人员需受一定量的X线辐射，对身体健康有一定的影响。     

X线下双银针定位法治疗金属异物

金属异物多位于皮下或肌肉层 ,常见于注射针头或针灸银针的断落以及土枪铁弹和生产劳动中的铁屑等。患者行走后常导致异物的明显移位 ,手术治疗非常困难。我们采用X线下双银针定位法治疗 8例 17次 (枪弹伤为多处 ) ,取得了满意效果 ,现报告如下。1　临床资料本组 8例 ,男 7例 ,女 1例 ,年龄 36～ 6 8岁 ,其中注射针头断落臀部 1例 ,银针断落臀部 1例 ,铁屑击伤上臂 4例 ,土枪弹击伤臀部 1例 ,背部 1例 ,土枪弹伤为多处散在伤 ,共 17处。所有患者伤后都有走动 ,其中 2例曾经某医院手术 ,未获成功。手术方法 :患者卧于X线操作平台 ,X线下透…     

X线透视引导下应用三维定位器行软组织内异物取出术的疗效分析

目的探讨软组织内异物的治疗方法。方法软组织内异物患者742例,均为外院手术失败来我院就诊者。均在C臂X线机透视引导下采用异物定位器定位经皮异物钳取出异物。结果异物包括铁屑、断针、铁钉、钢丝等。位于颈部、胸腹部、盆部、四肢等软组织内。异物取出率100％。无出血、感染、神经损伤等并发症。平均手术时间5min。结论异物三维定位器和特制异物钳在X线透视引导下经皮异物钳取出术微创、安全、有效。     

Handheld ultrasound device for detection of non-opaque and semi-opaque foreign bodies in soft tissues

PURPOSE: The aim of this study was to determine whether a portable handheld ultrasound device can be used to visualize non-opaque and semi-opaque foreign bodies in soft tissues and to characterize their sonographic appearance. METHODS: Twenty-two fragments composed of various natural and man-made materials and ranging from 4 to 20 mm in the maximum longitudinal dimension were embedded into 2 thawed turkey breasts. Two sonographers who were unaware of the number, dimensions, and locations of the fragments used a handheld ultrasound device to detect and characterize the fragments on the basis of their surface echogenicity and acoustic shadowing. The sonographic appearance of each fragment was compared with its actual characteristics. RESULTS: All 22 embedded fragments were successfully identified and localized on sonography. Surface echogenicity and acoustic shadowing varied among the fragments. For some fragments, the sonographically measured maximum longitudinal dimension differed substantially from the actual dimension. CONCLUSIONS: Use of a portable handheld ultrasound device is effective for the detection of foreign bodies with a diameter greater than 4 mm in soft tissues. The sonographic appearances of non-opaque and semi-opaque foreign bodies vary in their patterns of surface echogenicity and acoustic shadowing.     

Detection of soft tissue foreign bodies in the presence of soft tissue gas.

OBJECTIVE: To determine the effect of soft tissue gas on the accuracy of foreign body detection by realtime sonography. METHODS: This was a prospective randomized study using glass, metal, and bone inserted into turkey breasts to simulate human soft tissue foreign bodies. Air was subsequently injected around a random selection of the foreign bodies to simulate soft tissue gas that can accompany a blast or high-force injury. Using a linear transducer, physicians credentialed in the use of sonography were each asked to scan the breasts, identify the location of any foreign body, and describe whether the object located was bone, metal, or glass. They were also asked to describe the characteristics of the foreign body, including surface echogenicity, visibility, and artifacts, if any. RESULTS: The sensitivity for localization of each foreign body by each sonographer was 100% (48 of 48) and was unaffected by the presence of soft tissue gas. The accuracy of classifying the foreign body was poor except with bone. Glass and metal were often confused with each other. With the addition of soft tissue gas over the foreign bodies, the sensitivity of classifying the foreign body was decreased further from a combined 58% to 28%. The presence of soft tissue gas decreased the amount of reflection of the foreign body and obscured the subtle differences in the brightness of each foreign body, leading to a decrease in the accuracy of identification but not localization of the foreign body. CONCLUSIONS: In an experimental model, soft tissue gas does not affect the localization of soft tissue foreign bodies. However, correct identification of the type of foreign body is limited by soft tissue gas because of loss of the typical sonographic characteristics.     

Accuracy of bedside ultrasound for the detection of soft tissue foreign bodies by emergency doctors

Objective: To assess the ability of emergency physicians and emergency trainees to detect soft tissue foreign bodies using typical ultrasound equipment. Methods: Following a 20 min interactive training session, emergency physicians and emergency trainees were assessed on ability to identify subcutaneous foreign bodies (wood, glass, plastic, gravel and metal) embedded in an experimental model containing both sham and real entry point incisions. In the second phase of the experiment accuracy of detection of multiple foreign bodies was assessed in a similar sonographic phantom. Results: Six emergency physicians and 14 emergency trainees performed a total of 400 individual sonographic examinations. Emergency physicians correctly identified 29 of 30 foreign bodies and returned sensitivity, specificity, positive predictive value and negative predictive value of 96.7%, 70%, 76.3% and 95.5%, respectively. Trainees correctly identified 60 of 70 foreign bodies and returned sensitivity, specificity, positive predictive value and negative predictive value of 85.7%, 82.9%, 83.3% and 85.3%. Correct identification of the number of foreign bodies present, when multiple, was low (25% physician vs 36% trainee). Conclusion: These data suggest ultrasound in the hands of emergency doctors might be useful as an initial screening tool for detection of soft tissue foreign bodies.     

A review of gastrointestinal foreign bodies

Gastrointestinal tract (GIT) foreign bodies represent a significant clinical problem in the Emergency Department, causing a high degree of financial burden, morbidity and mortality. A large variety of foreign bodies are accidentally ingested or inserted into the GIT in different age groups. This a retrospective review of 38 patients who presented to the Emergency Department with GIT foreign bodies between January 2001 and December 2004. Computer database and case note search of patients' personal data, nature of the foreign objects and mode of entry to the GIT were recorded. There were 30 males and eight females (M : F ratio of 3.75:1) with an age range of 10 months to 87 years (median age 25.5 years). Foreign body ingestion/insertion was accidental in 14 patients, deliberate in 11, for anal erotism in 11 and as a result of assault in two cases. The median time before presentation was 12 h, and the mean length of hospital stay was 1.7 days. Treatment was conservative in 15 patients; five patients had gastroscopic retrieval; 15 patients underwent examination under anaesthetic, retrieval and proctosigmoidoscopy and three patients underwent laparotomy for impacted foreign bodies. GIT foreign body ingestion or insertion is common; however, majority of cases can be successfully managed conservatively.     

Bedside ultrasound for the detection of soft tissue foreign bodies: a cadaveric study

The objective of this study was to evaluate the sensitivity and specificity of bedside ultrasound, as performed by emergency physicians with typical equipment, in detecting small, soft tissue foreign bodies, using a cadaveric model. This was a prospective study, using 6 unembalmed human cadavers and 6 ultrasound-credentialed, emergency medicine residency-trained physicians as sonographers. Incisions were made in 150 total sites of the extremities and each site was randomly assigned one of five groups: wood, metal, plastic, glass, or no foreign body. All foreign bodies were 2.5 mm³ in total volume or less, no longer than 5 mm in any dimension, and inserted to a depth of up to 3 cm. Ultrasound was performed with a SonoSite TITAN^® (SonoSite, Inc., Bothell, WA) ultrasound system using a L38/10-5 broadband linear array transducer. Sonographers were blinded to the number, type, and location of foreign bodies. A total of 900 ultrasound examinations were recorded. Overall sensitivity of ultrasound for foreign body detection was 52.6% (95% confidence interval [CI] 48.9%–56.2%), and overall specificity was 47.2% (95% CI 39.9%–54.5%). Positive predictive value was 79.9% (95% CI 76.3%–83.5%), and negative predictive value was 20.0% (95% CI 16.2%–23.7%). Sensitivity for individual sonographers ranged from 40.8% to 72.3% (average 52.6% ± 13.3%), and specificity ranged from 30% to 66.7% (average 47.2% ± 15.1%). Inter-observer reliability was poor. In our model, bedside ultrasound performed by emergency physicians was neither sensitive nor specific for the presence of small soft tissue foreign bodies.     

Case of impacted subglottic metallic foreign body removal without tracheostomy through an endotracheal tube

A foreign body in the upper airway can cause serious morbidity and mortality, especially in pediatric patients. This case report describes an innovative way to remove an impacted foreign body distal to the vocal folds through an endotracheal tube without tracheostomy.     

Sonographic surface localization of subcutaneous foreign bodies and masses

We report a sonographic technique of skin marking of the projection of nonpalpable subcutaneous foreign bodies and masses using a paperclip. Localization and marking of the overlying skin assists in preoperative planning and further management. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009     

A simplified training method for soft tissue foreign body detection using ultrasound in emergency medicine residency program

Using ultrasound for detecting soft tissue foreign bodies seems to be the preferred choice with minimum invasion and easy availability at the bedside in emergency departments. In this study, a workshop (1 hour of lecture presentation and 3 hours of interactive hands-on) was designed to evaluate the efficacy of a short course of simple interactive training to improve the ability of emergency medicine residents to detect foreign bodies with ultrasound. Eight pieces of fresh full thickness (10 × 10 × 10 cm) lamb leg muscle were used in this study. Five different types of foreign bodies, including: a piece of glass (5 × 5 × 4 mm), wood (5 × 5 × 4 mm), gravel (5 mm diameter), plastic (5 × 5 × 2 mm) and a nail (25 mm in length) were placed deep inside each lamb leg. An ultrasound machine with a 7.5 MHz linear probe was used in this study. 35 emergency medicine residents (12 PGY1, 11 PGY2 and 12 PGY3) were enrolled in this study. Pretest and post-test results were compared and analyzed. Among all 35 participants in the training session, foreign body detection was significantly improved after the workshop (p < 0.001). Overall sensitivity and specificity for differentiating the presence and absence of a foreign body with 95% confidence were 60% (75% for PGY3) and 85.7% (91.7% for PGY3), respectively. The overall accuracy increased from 20.2% to 72.8% due to this session. This study supported the possibility of using ultrasound to detect foreign bodies by emergency physicians with a very short training course. This is highly beneficial for overcrowded emergency departments.