Hot Seat #169: 4 yo with foreign body

Posted on: April 1, 2021, by :

4 yo M with no PMH presenting with foreign body in his left foot. Per parent, he stepped on a sewing needle 2 days ago while barefoot. His father thought he had completely removed the needle at the time. His father has noticed redness and swelling of the foot today, worsening pain when walking. He is still able to ambulate. No fevers, tolerating p.o.

They were seen at an outside hospital today where x-rays demonstrated a linear radiopaque foreign body in the foot.

NKDA

No medications

Imm UTD

PMH: No medical problems, no history of anesthesia, no asthma

PSHnone

FHx: No issues with anesthesia

ROS

Constitutional: denies fever

Skin: as per HPI

Respdenies shortness of breath

GIno vomiting

Neuro no altered level of consciousness

Heme/Lymphbleeding tendency negative

All/Imm: no impaired immunity

Physical Examination

Vital signs: T 36.8, HR 96, BP 98/61, RR 24, 98% RA

General: Alert, appropriate for age, cooperative

Skin: Left foot swollen and erythematous on plantar and dorsum surfaces, 1 mm area of broken skin on plantar foot with callus over it, pain with palpation over broken skin and areas of surrounding erythema

CVRRR, no murmur. Cap refill <2 s

RespLungs are clear to auscultation

GISoft, non-tender, non-distended

MSK: Normal ROM of L hip, knee, ankle, toes. L knee and ankle without palpable effusions. Normal strength. Ambulates with a limp

Neuro: No focal neurological deficit observed

You obtain an XR of the left foot which demonstrates: 1.9 cm Foreign body in the plantar soft tissues adjacent to the first proximal phalanx compatible with a needle. No abnormality in the adjacent bones.

You consult orthopedics for removal and they recommend labs which result as follows: WBC 12.65 K/mcL, ESR 42 mm/hr (nl 0-20), CRP 1.9 mg/dL (nl 0.05-1.0), blood culture pending.

The information in these cases has been changed to protect patient identity and confidentiality. The images are only provided for educational purposes and members agree not to download them, share them, or otherwise use them for any other purpose.

1 thought on “Hot Seat #169: 4 yo with foreign body


  1. Although ultrasound wouldn’t be the definitive imaging to evaluate for osteomyelitis, you can see subperiosteal fluid collections on ultrasound, which would be very concerning for osteo. You could assess for this with a quick bedside ultrasound, which could also give you a little more information about the location of the needle and help you assess the level of soft tissue swelling/cellulitis.

Leave a Reply

Your email address will not be published.