Glass Foreign Body Detection and Management

Detection Characteristics of Glass on Radiography

Glass is radiodense and can be detected on x-rays, unlike truly radiolucent materials such as wood, plastic, and rubber, as recommended by the American College of Radiology 1, 2
Small fragments may be missed on x-ray, especially if obscured by adjacent osseous structures, according to the American College of Radiology 1, 2

CT is superior to radiography, being 5-15 times more sensitive for detecting foreign bodies, as stated by the American College of Radiology 3
Glass appears moderately hyperdense on CT (at least 2000 Hounsfield units), making it readily distinguishable from soft tissue, according to the American College of Radiology 3
Ultrasound shows all foreign bodies as hyperechoic with posterior acoustic shadowing and can provide real-time guidance for removal, as recommended by the American College of Radiology 3, 4

Never rely solely on negative radiographs to exclude glass foreign bodies, especially for small fragments or those in anatomically complex areas, as warned by the American College of Radiology 1, 2
Retained glass can trigger granulomatous reactions and subsequent soft tissue infections including cellulitis, abscess formation, or sinus tracts, according to Praxis Medical Insights 4, 5

Obtain radiographs first (multiple views) for any suspected glass foreign body, as recommended by the American College of Radiology 1, 2, 4
If x-ray is negative but clinical suspicion remains high, obtain ultrasound immediately, as suggested by the American College of Radiology 3, 4
Consider CT if ultrasound is unavailable or if precise localization relative to critical structures is needed before removal, according to the American College of Radiology 3, 4