Rads still better.....

Veterinary Radiology & Ultrasound, 2023

Author

Obi Veterinary Education
August 01, 2025

Emily M. Brand, Kenneth J. Brand, Jessica A. Ogden, Chee Kin Lim, Hock Gan Heng


Background
Retained surgical sponges or gauzes (RSS) are an uncommon but serious postoperative complication in veterinary medicine. They can cause inflammatory responses, leading to abscess formation or granuloma development. While RSS have been described in chronic cases, their ultrasonographic appearance in the acute postoperative period (24–48 hours) is poorly characterized. This study aimed to define the ultrasonographic features of RSS using phantom and cadaveric models.

Methods
A prospective, two-part descriptive study was conducted. The first part involved placing radiopaque and non-radiopaque surgical sponges and gauzes in a gelatin phantom and evaluating their ultrasonographic appearance. The second part involved placing these materials in the peritoneal cavity of 20 canine cadavers at three randomized locations during an exploratory laparotomy. The cadavers were scanned 17 hours postoperatively using ultrasonography, and imaging features were analyzed.

Results
In the phantom model, RSS appeared as multiple hyperechoic layers with fine striations and variable distal acoustic shadowing. In cadavers, all RSS (100%) displayed a single hyperechoic layer of variable thickness with distal acoustic shadowing. A thin hypoechoic layer superficial to the hyperechoic layer was noted in 95.6% of cases. Reverberation artifacts were observed in some cases, particularly in radiopaque sponges. These findings differed from previously reported chronic RSS cases, which often present as mass-like structures.

Limitations
This study used cadavers rather than live patients, meaning inflammatory responses could not be fully assessed. Additionally, variability in gas presence within the peritoneal cavity may have influenced imaging results. The small sample size and variability in sponge and gauze placement also limit generalizability.

Conclusions
In the acute postoperative period, retained surgical sponges and gauzes have a characteristic ultrasonographic appearance, including a hyperechoic layer, a thin superficial hypoechoic layer, and distal acoustic shadowing. These features may help differentiate RSS from normal postoperative changes. The findings support the use of ultrasonography as a diagnostic tool, though radiography remains superior for detecting RSS with radiopaque markers.

B-mode ultrasound images of the cadavers and features of the hyperechoic layer. Images A–C, E, and F were acquired with a largeconvex array probe (4 MHz), and image D was acquired with a linear array probe (12 MHz). A, Radiopaque gauze with a thick, irregularlymarginated hyperechoic layer. B, Radiopaque sponge with a thin, smoothly marginated hyperechoic layer. C, Nonradiopaque gauze with a thick,smoothly marginated, continuous hyperechoic layer. D, Radiopaque sponge with a thin, irregularly marginated, discontinuous hyperechoic layer.Arrow is pointing to the region of discontinuity. E, Nonradiopaque gauze with a thin, smoothly marginated hyperechoic layer. F, Radiopaque gauzewith a thick, irregularly marginated hyperechoic layer. [Color figure can be viewed at wileyonlinelibrary.com]

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