Presentation
Bedouin with a forefoot swelling over the first metatarsal bone with a skin opening discharging pus for 4 months.
Patient Data
No radioopaque foreign body can be discerned.
Ultrasound of dorsum of right foot swelling revealed a linear echogenic subcutaneous structure superficial to the distal half of the first metatarsal bone and proximal to the first metatarsophalangeal joint measuring 3 cm with a surrounding hypoechoic zone that shows increased vascularity.
Author: Abalg
Source: https://commons.wikimedia.org/wiki/File:Acacia_tortilis_var._raddiana_(Rissani-Nekob,_Maroc).jpg
Original file: Acacia tortilis subsp. raddiana
Modifications: none
Licence: This file is licensed under the Creative Commons Attribution-Share Alike 4.0 International license.
Case Discussion
The patient was in doubt about a foreign body insertion while walking in the desert since 4 months. Ultrasound shows features of foreign body granuloma surrounding a retained echogenic foreign body superficial to the first metatarsal. On surgical extraction, the foreign body revealed to be a thorn of umbrella thorn (Acacia tortilis) tree, a common desert tree with long hard thorns.
Wooden foreign bodies are commonly radiolucent, so cannot be ruled out by negative radiographs. They are rather detected in ultrasonography as echogenic structures with high sensitivity for small sizes 1.
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