 Greetings to all, I am Dr. Arjun Mathal, videology resident, studying in Christian Institute of Medical Sciences, Karad Maharashtra, will be presenting my paper under the guidance of Dr. Prakash Patil and Dr. Mool Goethe on the topic of sonographic evaluation of soft tissue and hollow viscous foreign bodies. Soft tissue foreign bodies are usual in clinical practice, it is difficult to confirm their presence in soft tissues because X-ray only detects radiopic foreign bodies. Sonography can be an useful diagnostic imaging method for visualization and localization of a non-radiopic and also radiopic foreign bodies in soft tissues. Approximately nautical localization in respect with superficial skin markings under guidance is possible with sonography and it can facilitate their speedy surgical removal. Complications associated with foreign body objects like abscess formation, danylomas, pseudo anaerysm, enosynovitis can be well documented with sonography. In recent times ultrasound has become an optimal imaging modality for the detection of both radiopic and radio lucid foreign bodies because of its high sensitivity and specificity also it is widely available and accessible with portable scanners and of course it does not involve any anaerysm radiation. A high frequency linear array transducer is optimal for sonographic evaluation of suspected foreign body of the musculoskeletal system. Equigenicity of a foreign body is related to the nature of the object itself although foreign bodies of the musculoskeletal system usually show hyper-equigenicity. In contrast artifacts occurring deep in relation to the foreign body depends on the characteristics of the object surface and a foreign body with a with an irregular or curved surface will produce post-tech optic shadow and if the surface is flat and smooth dirty shadows produce which is known as posterior reverberation or comatill artifact. The latter finding has been described for metal fragments glass and plastics. So coming to aims and objectives of my study to evaluate the diagnostic efficacy of ultrasonography in detection and exact localization of non non-opic and radio opaque foreign bodies. In the study total 35 patients were evaluated with suspected and unsuspected foreign body in soft tissue and they were examined on Biprogealogic P9 color Doppler system using high frequency linear array probe. Ultrasonography was done along longitudinal and transverse axis after clinically evaluating patient's stiff campaign and the site of penetrating injury. Whenever a foreign body was localized by ultrason its length, breadth and its depth from the skin were measured using calipers on monitor. Ultrason findings of various soft tissue foreign bodies were recorded that include their echogenicity, posterior caustic shadowing, posterior reverberation artifact and a helosine in each and every patient. Also their complications like abscess formation, sinus anovitis and pseudo aneurysm were recorded. Coming to my first case of a retained glass foreign body in a 35 year old female with a history of broken glass injury, 25 years back who presented with complaints of localized pain over the dorsal aspect of the left hand around the scar side. Entered a posted and lateral radiographs of the left hand shows a small radio opaque fragment over the dorsal aspect of the left hand. Superficial longitudinal ultrasound image of the constant region shows a linear echogenic focus with surrounding hypoechoic area and certain granulation tissue. The echogenic foci is giving the posterior reverberation artifact. On color Doppler studies the foreign body is seen abutting the ulnar artery. Second case is of a Khaan with a granuloma formation. In the first image we can appreciate a linear hyperquake structure measuring approximately 1 centimeter giving posted a caustic shadow with surrounding helo. In the second case the linear hyperquake structure measuring approximately 2 centimeter giving posted a caustic shadow is noted with surrounding helo. This helo is a hyperquake collection representing the granuloma tissue and this was noted in the subcutaneous claim over the dorsal aspect of the left forearm approximately 10 centimeter from the oligotron process of the ulnar in a young female with a history of fall over a thorn bush 3 weeks ago. This is an interesting case where a thorn foreign body led to a pseudoenethasome formation. In this ultrasonographic longitudinal and transverse images we can appreciate a linear hyperquake thorn structure giving posted a caustic shadow with surrounding heteroquake predominantly hyperquake collection likely access formation on the ventral aspect of the right forearm. The tip of the foreign the tip of the foreign body is seen abutting the radial radial artery on color Doppler studies show surrounding pseudoenethasome formation. In this case of a 25 year old male farmer with history of thorn prick injury over the posterior middle aspect of the left floor leg ultrasonographic images shows a linear hyperquake foreign body giving posted a caustic shadow with tip the tip of the foreign body is seen abutting the serosa of the left posterior tibial artery. This is a case of a foreign body thorn with the abscess formation. In this ultrason done in longitudinal and transverse plane of the thinner eminence of the left hand shows a linear hyperquake structure giving posted a caustic shadow in the muscular plane which is consistent with wood foreign body thorn as per the history of the thorn prick given by the patient. Small hyperquake collection is noted around the thorn which represents abscess formation. In this case a 20 year old 20 years old male farmer came with thorn prick one month back while working in the field. He complains of pain and swelling in the lateral aspect of the right leg below the knee lateral to the tibial fibrosity. Ultrasonography in longitudinal and transverse plane revealed a retained linear hyperquake structure adjacent to the tibial fibrosity with posted a caustic shadow in the muscular plane which is consistent with the thorn. This surrounding this surrounding heteroquake predominantly hyperquake collection showing no vascularity in color doctor studies which likely represent abscess formation surrounding the retained foreign body. This is the case of thorn foreign body induced tinoxinovitis. So the patient had a history of thorn injury to the right little finger 15 days back. Now he complains of swelling and pain over the farmer aspect of the middle phalanx. On ultrasonographic examination of the site of interest a linear hyperquake structure approximately 8 mm in length is noted abutting flexor tendon near the base of the middle phalanx. There is synovilch sheet thickening with mild fluid around the tendon sheet. There was no tear in the sheet noted and no proximal interphalange or distal interphalange joint effusion was noted on the studies. This was a foreign body likely thorn induced tinoxinovitis of the finger. This is another case which shows small hyperquake foci with posterior caustic shadow abutting the flexor heliocis bravest tendon. There is mild synovil thickening with fluid in the tendon sheet. This was a wooden foreign body induced tinoxinovitis of a flexor heliocis bravest tendon. This is the case of a middle aged female with history of painful swelling at the eclis tendon insertion 2 years post traumatic bone at the same location. Datograph lateral view of the left foot shows a small area of soft tissue swelling depicted by a red circle posted to the eclis tendon insertion sorry ultrasonographic transverse and longitudinal study of the constant vision shows a heteroequic heteroequic predominantly hyperquake lesion in the subcutaneous tissue posted to the eclis tendon with internal ecos. There is a linear hyperquake structure measuring approximately 3 centimeter noted giving posterior caustic shadow depicted by the dotted arrow lines. This represent an inflammatory granuloma with internal ecos surrounding foreign body likely wood spinter. In this case we can appreciate a linear hyper hyperquake structure giving posterior caustic shadow in the inter muscular plane of the right forearm lying approximately 1.9 centimeter deep and perpendicular to the skin. There surrounding hyperquake hyperquake collection giving a halo sign around the hyperquake structure findings are consistent with foreign body wood spinter with surrounding granuloma. Skin marking was done to guide the surgeon for the easy removal of the foreign body. This is the pictorial depiction of the skin marking done to guide the surgeon for the easy removal of the foreign body. In this case a middle aged man working in a furniture factory came with the history of wood spinter brick while working 2 weeks ago. Now he complains of pain and swelling on the pulp of left little finger since then. Ultrasonographic transverse and longitudinal images depicts a linear hyperquake structure in the subterranean plane at the site of concern giving posterior caustic shadow consisting with wood spinter a small oval hyperquake collection giving a halo appearance is noted around the thorn likely granuloma formation as an inflammatory tissue reaction around the retained foreign body consisting of hematoma edema and granulation tissue. This is a case of a middle aged labourer with history of right hand injury 10 days back now complains of pain and swelling at the site of injury. Ultrason was performed and it shows 2 hyperquake foci approximately measuring half centimeter giving posterior reverberation artifact in the subterranean plane and this was lying approximately 0.18 centimeter from the skin against the middle phalangeal joint of the first digit of the right hand. These are a thin hyperquake rim surrounding the hyperquake foci findings are consistent with the foreign body tile particles as confirmed on post surgical removal with surrounding granuloma. This is another case of a stone as a foreign body we can appreciate a hyperquake structure with posterior reverberation artifact in the subterranean plane in the second web space of the left foot in a 26 year old male who got foot injury while playing cricket 2 weeks ago. This surrounding heteroquake predominantly hyperquake collection with minimal peripheral vascularity on coladoptera studies it was found to be a stone pallet with abscess formation. We can appreciate the hyperquake stone pallet with surrounding abscess formation. So a 7 year old female child presented with the pain in abdomen after accidentally solving a coin to the surgical OPD initial examination with the help of erect abdominal radiograph shows an oval foreign body at the level of D12 L1 vertebra likely suggest of foreign body metal coin in the diodenum. The patient was subjected to Albre sound which shows a round hyperquake structure giving posterior reverberation artifact confirming the impacted coin in the first part of the diodenum later the patient was subjected to endoscopic removal of the foreign body. So this is the case of a stretch granuloma which is also known as Stauffler's tumor. So in the following images we can appreciate the granuloma seen as hyperquake collection in the anterior abdominal wall surrounding the sutures from a previous surgery of the right-wing venal hernia one year before in a 67 year old male. Now he presented with the local swelling redness and pain at the scar side. Small hyperquake foci in the surrounding hyperquake collection depicts the suture material and they give a parallel hyperquake real like morphology. So this is the case of a gossipy boomer a 25 year old female presented with insidious onset wake lower abdominal pain discomfort and abdominal dissension which gradually increased since last five days. The symptoms were associated associated with fever. She had a history of cesarean section 17 days ago on physical examination. She had a round palpable mass in lower abdomen associated with tenderness. Patient was initially referred to the to our department for ultrasound of abdomen and pelvis and CT scan was additionally performed for further radiological evaluation. So on ultrasound it showed a well-defined thick walled complex hyperquake intraparitoneal mass containing multiple curvilinear hyperquake foci depicted by yellow arrow and multiple areas of dirty shadowing the dirty shadowing denoted by red arrows and the lesion was seen separate from the uterus and there was no vascularity on the color doctor studies. The patient was subjected to CT and on CT we can appreciate a well circumscribed and encapsulated intraparitoneal hypodense lesion showing spongiform appearance with gas bubbles within a curvilinear hyperdense structure denoted by arrows showing a metal metallic density of more than h u more than 1000 within the lesion surrounded by the gas bubble. This was a in the postoperative findings were like interoperative findings were a sponge retained sponge in the pelvis with the surrounding abscess formation. So coming to the results total 41 foreign bodies was seen as hyperquake foci in 35 patients posterior caustic shadow shadow was seen in wooden objects like and thorns etc and like out of 41 36 36 foreign body shows posterior caustic shadow and posterior reverberation artifact was seen in patient having broken glass point and metal object foreign bodies 15 patients were having hello sign due to granulation tissue formation 9 were having abscess formation surrounding the foreign bodies out of 35 patients 32 patients underwent surgery and 38 foreign bodies were removed and 3 patients were lost to follow up and out of 35 patients 6 patients were having persistent localized pain that is in an they were the they were considered as unexpected cases. So this graphical this graphical representation shows that out of 100% it is 88% within foreign bodies shows posterior caustic shadow and only 12% shows posterior reverberation artifact. In this graphical depiction we can we can see the wooden among the wooden splinter wood splinter and thorn thorn is the most common foreign body which was studied on the in my study on ultrasound and they appear radio radio lucent on x-rays these these these foreign bodies appears radio opaque on the on the initial x-ray and among them metal is the most common foreign body studied on the ultrasound in my study. So sonography sonography is cost effective easily available and non ionizing imaging modality it can be used effectively to locate radio lucent and radio opaque foreign bodies with high certainty and should be considered as modality of choice for patients with suspect who are suspected of having a foreign body in the setting of negative x-rays also in missed or under diagnosed cases with retained foreign bodies skin marking was done after thorough examination using marker pen for anatomical orientation of the foreign body to the surgeon in respect to the nearest possible route for ease of its removal. The sonographic findings were correlated with the surgical findings. So coming to the summary of my presentation. So a foreign body on x-ray can be radio opaque or radio lucent. Radio opaque foreign body are they include metals glass or stone and radio radio lucent foreign body includes wooden plastic pieces. So the radio on ultrasonography the radio opaque foreign body will appear as hyperequic with ocular reverberation artifact whereas a radio lucent foreign body will appear hyperquic with pocine acoustic shadow. These are my references. Thank you so much.