Ultrasound-assisted foreign body extraction (U-SAFE): Review of technique and technical pearls.

INTRODUCTION: Soft tissue foreign bodies are a common presentation to emergency departments and primary care. They have variable presentations and associated morbidity depending on their acuity, location, functional impairment and neurovascular involvement. Traditional removal has utilised blind technique or surgical exploration. Their removal can be difficult secondary to induration, inflammation, granulation and scar tissue. Ultrasonography has emerged as a minimally invasive and inexpensive method of examination and retrieval. This article entails ultrasound-guided foreign body extraction with associated pearls of experience. METHODS: From March 2017 to August 2020, a fellowship trained interventional radiologist and a fellowship trained musculoskeletal radiologist performed 52 foreign body extractions under ultrasound guidance at a single institution. RESULTS: 52 foreign body extractions occurred over 3-year time period with a 95% success rate. The most common location of foreign body was the finger (62%) and feet/toes (17%). Foreign bodies identified include wood (31%), plant-based material (29%), metal (17%), glass (17%) and synthetic material (6%). Two unsuccessful cases were secondary to delayed presentation with significant foreign body reaction and the 2nd due to patient psychiatric issues. There were no identified complications. CONCLUSION: Ultrasonography-guided foreign body extraction is a minimally invasive, efficient and targeted technique for foreign body removal.

Magnetic resonance characterisation of primary Raynaud's phenomenon.

The objective findings of phalangeal T2-weighted hyperintense and T1-weighted hypointense bone marrow signal on MRI without features of seronegative arthropathy or osteomyelitis may assist clinicians in making a diagnosis in the appropriate clinical context.

Parosteal lipoma of the rib: A rare condition in an uncommon location.

A 36-year-old female patient was diagnosed with a parosteal lipoma arising from the left 3rd rib. This was preluded by a 5-year history of an asymptomatic and stable mass at the medial aspect of the left scapula. It had displayed an interval enlargement in the preceding 3 months which prompted investigation to rule out an aggressive lesion. The patient was investigated with CT, MRI and PET scan which demonstrated a well-circumscribed juxtacortical fatty mass with osseous excrescence and no enhancing soft tissue components or FDG avidity in the fatty component, in keeping with a parosteal lipoma. CT-guided biopsy allowed histopathological correlation which facilitated the exclusion of an aggressive lesion and supported the imaging diagnosis. This case is a pertinent educational tool for radiologists and orthopaedic surgeons as it characterises a rare and benign pathology in an uncommon location, with mimicry of malignant differential diagnoses such as liposarcoma and chondrosarcoma. We aim to bring awareness to this condition and its typical imaging characteristics and thus allowing radiologists to make more confident conclusions in future cases.

Ultrasonography-Guided Common Musculoskeletal Interventions from Head to Toe: Procedural Tips for General Radiologists.

The expanding scope of interventional musculoskeletal procedures has resulted in increased pressure on general radiologists. The confidence of general radiologists in performing ultrasound-guided musculoskeletal procedures varies with their clinical exposure. This didactic review provides a methodologically and clinically oriented approach to enhancing user understanding and confidence in performing ultrasound-guided musculoskeletal procedures. The body of the text is accompanied by figures depicting the procedural approach, injection site, and labeled ultrasonography images. This paper aims to provide a teaching and bedside aid for education on and the execution of musculoskeletal procedures to ensure the provision of quality health care.