Case Report: High-Frequency Ultrasonography of Foreign Body Granuloma

Abstract

Introduction and objectives.Foreign body granuloma is a benign lesion resulting from chronic inflammation, that develops as a response to materials, that are perceived as harmful. Diagnosis is primarily clinical, characterized by tenderness, swelling and erythema. However, it is crucial not to overlook radiological evaluation as initial examinations may miss up to 38% of retained foreign bodies. High-frequency linear ultrasound transducers have demonstrated excellent sensitivity and specificity for detecting subcutaneous foreign bodies [1-3]. Materials and methods. A 23-year-old patient presented with a complaint of a tender lump in the chest area, causing discomfort. A history of a 2-month-old accident, during which the patient fell on glass shards was noted. A dermatological examination revealed an erythematous 6 x 7 cm diameter plaque with capillaries on the surface. Upon palpation, a hard, movable, tender subcutaneous formation was found. Results. A high-frequency ultrasonography (12-22 MHz) confirmed a hyperechoic broken glass foreign body visualising linear structure and generating shadowing with reverberation. A surrounding hypoechoic rim was seen as well, suggesting an inflammatory process. A chest X-ray was performed, showing a 1 cm foreign object of high intensity visible in the superficial soft tissues. A decision was made to surgically remove and analyse the formation histopathologically, resulting in the retrieval of a 1.9x0.5x0.3 cm glass shard. The histopathological examination showed chronic granulation tissue surrounding the foreign body, with the presence of singular lymphocytes, plasmacytes, and eosinophils in the dermis. A follow-up with the patient was made in 30 days – no complications were noted. Conclusions. We recommend high-frequency ultrasonography for the diagnosis of superficial foreign bodies, as it offers fast differentiation of materials, the ability to visualize radiotransparent objects, assessment of soft tissues, and real-time imaging capabilities.