Ultrasound-Guided Percutaneous Removal of Foreign Body Using Hydrodissection and Serial Dilators

Abstract

High-resolution ultrasound of the painful, swollen left heel of a 54-year-old man, who reported that his symptoms had lasted 4 months, showed retention of a wooden foreign body in the heel. After administering local anesthesia and making a 5-mm skin incision, we performed hydrodissection of the foreign body from the adjacent soft tissue under real-time ultrasound guidance, using a 1% lidocaine solution. Then, we introduced an 18-gauge spinal needle and inserted a guide-wire through the needle. After we removed the needle, we introduced serial dilators in sizes ranging from 7 French to 12 French along the guide-wire to create a tract for mosquito forceps. Then, we introduced the mosquito forceps and removed the wooden foreign body. Ultrasound-guided percutaneous removal of foreign bodies is quick and safe. We believe that hydrodissection makes removal easier and that use of serial dilators minimizes soft-tissue injury and makes it easier to introduce mosquito forceps.

4개월간의 좌측 후족부 동통 및 종창을 주소로 내원한 54세 남자에서 고해상도 초음파 검사상 좌측 후족부에 나무 양상의 이물이 관 찰되었다. 국소 마취제를 투여하고 5 mm 가량의 피부 절개 후 실시간 초음파하에 1% lidocaine 용액을 이용하여 이물과 주위 연부 조직을 박리하기 위해 hydrodissection을 시행하였다. 그 후 18-gauge spinal needle과 guide-wire를 삽입한 다음 needle을 빼내고, 이물을 쉽게 빼내기 위해 7에서 12 French의 guide-wire를 차례로 삽입한 다음 mosquito forceps를 이용하여 이물을 제거하였다. Hydrodissection 및 serial dilator를 이용한 초음파하 경피적 이물 제거술은 빠르고 안전한 방법이라 생각한다.