Saturday, October 3, 2009

Horse Racing and Foreign Bodies

Photo by raymond

Horse racing is an ancient sport. Its origins date back to about 4500 B.C, among the nomadic tribesmen of Central Asia (who first domesticated the horse). The sport has a history of nobility, but interest in the sport can be found at all rungs of the societal ladder. In the modern world, organized horse racing is done at a racetrack. Many horse racing tracks are quite old, and are constructed mostly of wood.

In this case, a 71 year old woman went to a race track four weeks ago, and felt a sharp pain as she ran her hand along a wooden railing. Her clinician suspected a wooden splinter, but was unable to detect one on clinical examination. She was sent for an MRI:

Sagittal T2 fat sat image reveals a linear structure (red arrow) surrounded by fluid.

Axial and coronal T2 fatsat images confirm the presence of a wooden splinter:

What is the best test for a foreign body? While MRI can reveal foreign bodies, it is not very sensitive for the presence of non-metallic foreign bodies. Thus, despite what we see in this case, if the clinical question is "rule out foreign body", one should generally start with an x-ray. If this is negative, one can go on to CT or ultrasound, with the choice depending many times on local clinical practice.

Remember— while MRI can detect foreign bodies, it is not the ideal test, particularly if the foreign body is non-metallic in nature.

Vic David MD

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