SHM Converge Scientific Abstract ePoster Gallery-Imaging the Invisible: Ultrasound Identification of a Wooden Toothpick

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A 69-year-old man with diabetes and peripheral neuropathy presented with severe left foot and leg cellulitis after stepping on something in his garage and trying to remove it himself. Exam showed marked swelling, erythema, tenderness, and a small plantar puncture wound. CT and MRI did not identify a retained foreign body or osteomyelitis, so he was treated with intravenous antibiotics.<br /><br />Bedside point-of-care ultrasound, however, showed soft tissue edema and a vertical acoustic shadow beneath the puncture wound, raising concern for a retained foreign body. Because the infection improved only minimally and suspicion remained high, podiatry performed surgical exploration. A 1.8 cm wooden toothpick was removed from the wound, after which the cellulitis improved and the patient completed oral antibiotics.<br /><br />The case highlights that radiolucent foreign bodies such as wood may be missed on plain radiographs, CT, and even MRI, especially when small or superficial. Ultrasound is particularly useful for detecting wooden foreign bodies because of their echogenic appearance and characteristic shadowing. The report emphasizes that when a retained non-metallic foreign body is suspected, bedside ultrasound can provide a rapid, targeted, and sensitive diagnostic tool that may outperform other imaging modalities.

Asset Subtitle

Ryan K. Ajgaonkar

Meta Tag

Author List Nilam J. Soni, Ryan K. Ajgaonkar, Sergio Mellado, Terry J.S. Lund, Victoria Cuello

Category Clinical Vignettes

Concept Radiolucent Foreign Body

Concept Point-of-Care Ultrasound

Concept Retained Foreign Body

Concept Echogenic Material

Concept Posterior Acoustic Shadowing

Distinguished Non-Finalist

Presenter Organization UT Health Science Center at San Antonio

Presenting Author Ryan K. Ajgaonkar

Track Adult

Keywords

diabetes

peripheral neuropathy

cellulitis

plantar puncture wound

retained foreign body

wooden toothpick

bedside ultrasound

acoustic shadowing

MRI

surgical exploration

Radiolucent Foreign Body

Point-of-Care Ultrasound

Retained Foreign Body

Echogenic Material

Posterior Acoustic Shadowing