Ultrasound for the evaluation of soft tissue foreign bodies before and after the addition of fluid to the surrounding interstitial space in a cadaveric model



      Point-of-care ultrasound may be used to facilitate foreign body (FB) localization and removal. We hypothesized that injection of normal saline adjacent to an FB may make it easier to detect.


      The study was performed on one embalmed human cadaver. Potential FB sites were created of wood (24), metal (24), and null (24). Two sonographers evaluated each of the 72 sites both before and after a 25-gauge needle was inserted into each incision and 3 cc of normal saline was injected. Accuracy, sensitivity, and specificity were calculated both before and after injection of normal saline. Binomial tests were used to determine the statistical significance of FB detection before and after injection. A 2-tailed Student's t test was used to determine if there was a statistically significant difference between the 2 methods.


      Preinjection, 116 (81%) of the 144 interpretations (P ≤ .001) were correct in their assessment of whether or not an FB was present, with a sensitivity of 81% (95% confidence interval [CI], 72%-88%) and a specificity of 79% (95% CI, 65%-90%). Postinjection, 119 (83%) of these 144 interpretations (P ≤ .001) were correct in their assessment of whether or not an FB was present, with a sensitivity of 85% (95% CI, 77%-92%) and a specificity of 77% (95% CI, 63%-88%). This difference was not significant (P = .08; 95% CI, −0.04 to 0.01).


      Ultrasound was reasonably accurate, sensitive, and specific in identifying 1-cm metal and wood FBs. Although accuracy and sensitivity did improve after normal saline injection, this difference was not significant.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Levine MR
        • Gorman SM
        • Young CF
        • Courtney DM
        Clinical characteristics and management of wound foreign bodies in the ED.
        Am J Emerg Med. 2008; 26: 918-922
        • Blankenship RB
        • Baker T
        Imaging modalities in wounds and superficial skin infections.
        Emerg Med Clin North Am. 2007; 25: 223-234
        • Graham Jr., DD
        Ultrasound in the emergency department: detection of wooden foreign bodies in the soft tissues.
        J Emerg Med. 2002; 22: 75-79
        • Wang R
        • Frazee B
        Visual stimulus: splinter localization with ultrasound.
        J Emerg Med. 2011; 41: 294-295
        • American College of Emergency Physicians
        Emergency ultrasound guidelines.
        Ann Emerg Med. 2009; 53: 550-570
        • Orlinsky M
        • Knittel P
        • Feit T
        The comparative accuracy of radiolucent foreign body detection using ultrasonography.
        Am J Emerg Med. 2000; 18: 401-403
        • Crystal C
        • Masneri D
        • Hellums J
        Bedside ultrasound for the detection of soft tissue foreign bodies: a cadaveric study.
        J Emerg Med. 2009; 36: 377-380
        • Hill R
        • Conron R
        • Greissinger P
        Ultrasound for the detection of foreign bodies in human tissue.
        Ann Emerg Med. 1997; 29: 353-356
        • Saul T
        • Siadecki SD
        • Rose G
        • Berkowitz R
        • Matilsky D
        • Godbold J
        • et al.
        Ultrasound accurately identifies soft tissue foreign bodies in a liver anesthetized porcine model.
        Acad Emerg Med. 2015; 22: 950-954
        • Ginsburg MJ
        • Ellis GL
        • Flom LL
        Detection of soft-tissue foreign bodies by plain radiography, xerography, computed tomography, and ultrasonography.
        Ann Emerg Med. 1990 Jun; 19: 701-703