Metallic Mercury in the Soft Tissues of the Hand: Case Report

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Abstract

Background. The likelihood of foreign bodies presence in the wound exists in almost any injury to the skin. The consequences of their ingress into the body are extremely varied: from the complete absence of symptoms to systemic toxicity, depending both on the nature of the embedded agent and on the way of its penetration. The data of the anamnesis and clinical examination of foreign bodies are not always convincing, and the results of conventional radiography, even with X-ray-positive foreign bodies, are often nonspecific. The parenteral ingression of metallic mercury is rare. In contrast to its access through the respiratory or digestive tract, this route has not been adequately studied. This clinical report is devoted to the clinical case of deliberate self-administration of metallic mercury into the soft tissues of the upper limb. Clinical case description. A 24-year-old patient sought medical help 2 years after the injury and tried to hide its circumstances during taking his anamnesis. Ultrasound played a decisive role in making the diagnosis (foreign body) and revealing its nature (metallic mercury). This indicates the high information content and specificity of ultrasound which exceeded the X-ray capabilities. Despite no signs of general and local toxicity, the presence of mercury in the body is unacceptable and requires the surgical treatment. Our case showed that mercury in soft tissues was limited to granuloma or was fixed inside fibrous tissue. This made it possible to remove it radically. Conclusion. Our observation suggests that ultrasound, in contrast to X-ray, is able to present a specific picture of the existence of metallic mercury in soft tissues. Therefore, it is advisable to include ultrasound in the examination algorithm if any foreign body (especially mercury) is suspected to detect or clarify its nature. If mercury is detected in soft tissues, the radical surgical treatment can be successfully performed, since the reaction of tissues around the mercury material (in the form of granuloma and the confinement of mercury spheres in a conglomerate of fibrous tissue) makes it possible to avoid the spread of mercury along the wound channel.

About the authors

I. G. Chulovskaya

Pirogov Russian National Research Medical University

Author for correspondence.
Email: igch0906@mail.ru
ORCID iD: 0000-0002-0126-6965

Irina G. Chulovskaya — Dr. Sci. (Med.), Professor, Department of Traumatology, Orthopedics and Military Surgery

Moscow

Russian Federation

K. A. Egiazaryan

Pirogov Russian National Research Medical University

Email: egkar@mail.ru
ORCID iD: 0000-0002-6680-9334

Karen A. Egiazaryan — Dr. Sci. (Med.), Professor, Head of the Department of Trauma, Orthopedics and Military Surgery

Moscow

Russian Federation

M. V. Lyadova

Pirogov Russian National Research Medical University

Email: mariadoc1@mail.ru
ORCID iD: 0000-0002-9214-5615

Maria V. Lyadova — Dr. Sci. (Med.), Professor, Department of Traumatology, Orthopedics and Military Surgery

Moscow

Russian Federation

V. S. Kosmynin

Pirogov Russian National Research Medical University

Email: dr.kosmynin@gmail.com
ORCID iD: 0000-0002-1006-4628

Vladimir S. Kosmynin — Orthopedic Surgeon

Moscow

Russian Federation

T. V. Strelka

Medical University “Reaviz”

Email: more.my.metall@gmail.com
ORCID iD: 0000-0002-9762-0227

Tat’yana V. Strelka — Student

Moscow

Russian Federation

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