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Abscess third phalanx

One year after foreign body
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Clinical information

The patient has a large soft tissue swelling on the ulnar side of the right third phalanx for the last 3 days. Although saying it's not painful signs show it most likely is: pulling back and moaning upon palpation and functional assessment, white face, sweating, vasovagal reaction. The patient appears to be cognitively limited (simpleminded) and has trouble understanding questions, answering them, but also to tell the full history. This was a complicating factor.

Brief description

The transducer was placed both transverse (short-axis) and longitudinally (long-axis) over the right third phalanx, and the large swelling on the ulnar side. A gel standoff was used to be able to visualize the phalanx and swelling.

  • SHAPE: a larger soft tissue swelling can be seen on the ulnar side of the right phalanx. The swelling has clear round borders. A smaller swelling can be seen on the dorsal side of the third phalanx. The tendon appears to be normal. 
  • ECHOGENICITY: a clear homogenous hyperechoic mass can be seen in the swelling appearing to be an abscess. 
  • CONTINUITY: No continuity problems could be seen, the tendon is still intact. 
  • DOPPLER: A small positive color Doppler signal can be seen. 
  • FUNCTIONAL: Upon ultrasound guided functional assessment of passive tendon gliding (extension/flexion) showed that the tendons appeared to be intact.

Ultrasound Images & Clips

Longitudinal: dorsal third phalanx (linear 15 Mhz transducer)
Longitudinal: dorsal third phalanx (linear 15 Mhz transducer)
Longitudinal: dorsal third phalanx (linear 15 Mhz transducer)
Longitudinal: dorsal third phalanx (linear 15 Mhz transducer)
Longitudinal: color Doppler dorsal third phalanx (linear 15 Mhz transducer)
Longitudinal: color Doppler dorsal third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: ulnar third phalanx (linear 15 Mhz transducer)
Transverse: measurement potential foreign body ulnar third phalanx (linear 15 Mhz transducer)
Transverse: measurement potential foreign body ulnar third phalanx (linear 15 Mhz transducer)
Xray: PA - right third phalanx
Xray: PA - right third phalanx
Xray: PA oblique - right third phalanx
Xray: PA oblique - right third phalanx
Xray: Lateral - right third phalanx
Xray: Lateral - right third phalanx

Conclusion

Based on the ultrasound findings and SonoSkills pathology checklist analysis I concluded:

  • Severe case of a third phalanx abscess (ulnar side) 
  • Potentially a foreign body measuring 0.59 cm 
Based on my ultrasound examination an X-ray was made concluding: "See ultrasound report. No foreign body to be seen on X-ray. Severe soft tissue swelling on the level of the ulnar side of the third phalanx, most likely an abscess". After the ultrasound examination and X-ray the patient was immediately sent to the surgeon for abscess drainage. A foreign body was found.

Details

  • Sex: Male
  • Age: 28
  • Body part: Right third phalanx
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photo Marc Schmitz
Author

Marc Schmitz

MSK Sonographer, SonoSkills

Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at the Laurentius Hospital in Roermond, the Netherlands.

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