Ultrasound for Suspected Glass Foreign Body in Hand
Initial Diagnostic Approach
- The American College of Radiology recommends obtaining plain radiographs immediately for any patient with a puncture wound or suspected glass foreign body in the hand, as glass is radiodense and visible on x-rays in the vast majority of cases 1, 2
- Glass is inconsistently visible radiographically only when fragments are very small or obscured by adjacent bone structures, but the vast majority of glass foreign bodies are detected on plain films 1, 2
- Ultrasound is the optimal imaging modality for radiolucent foreign bodies, not glass, but can be used for precise localization of glass fragments already detected on radiographs to guide removal 1, 2
- Ultrasound is valuable for detecting soft-tissue fluid collections and evaluating for concomitant soft-tissue infections that may develop around retained glass 1, 2
Limitations of Ultrasound
- Ultrasound can underestimate disease extent and has limited visualization of deeper structures, and bone and gas hinder ultrasound evaluation 1, 2
- For glass specifically, radiography remains superior for initial detection 1, 2
Clinical Management Algorithm
- Consider CT without IV contrast if precise localization is needed for surgical planning, as CT allows precise foreign body localization 1, 2
- Reserve ultrasound for guiding removal of known fragments or when radiographs are negative despite high clinical suspicion 1, 2