Foreign body - distal leg

Case contributed by Dr Maulik S Patel

Presentation

History of penetrating injury by wood splinter - anterior distal most of right leg (ankle region) 20 days ago. Complaining of persistent local pain and swelling.

Patient Data

Age: 12 years
Gender: Male
Modality: X-ray

There is soft tissue swelling on anterior aspect of distal leg and ankle region. There is no radiopaque soft tissue foreign body.

There is presence of Sever's phenomena (sclerosis of calcaneal apophysis). There is no bony abnormality.

Modality: Ultrasound

There is effusion in intact tibialis anterior tendon sheath. Tendon shows normal echopattern.

There are multiple linear echogenic foci with or without posterior acoustic shadowing; in subcutaneous plane of distal third of anterior leg - clinically area of swelling.  They are foreign bodies.

Largest foreign body is about about 40 mm long; lying superficial and parallel to tibialis anterior tendon in distal leg. 

There is a smaller linear foreign body (10 mm long lying deep and lateral to largest foreign body.

There are few smaller (1-3 mm) foreign bodies are seen in local subcutaneous collection. They are superficial to tendon. Collection is about 40 x 20 x 5 mm.

All foreign bodies are cranial to skin entry wound.

There is no foreign body in tendon sheath. There is no ankle effusion. There is no erosion of adjacent tibial cortex.

Case Discussion

Findings of multiple subscutaneous tissue foreign bodies in anterior aspect of distal leg region due to fragmentation of foreign body. There is associated tibialis anterior tenosynovitis and local subcutaneous small collection without periosteal reaction in adjacent tibial cortex.

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Case Information

rID: 45191
Case created: 17th May 2016
Last edited: 23rd Dec 2016
Inclusion in quiz mode: Included

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