Lionfish and Stonefish Envenomation Workup

Updated: Jan 13, 2017
  • Author: Scott A Gallagher, MD, FACEP; Chief Editor: Joe Alcock, MD, MS  more...
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Workup

Laboratory Studies

No specific laboratory tests are indicated for the management of Scorpaenidae envenomations. In cases of severe systemic symptoms, a complete workup to exclude other etiologies may be warranted.

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Imaging Studies

Plain film radiography

Soft tissue radiographs are advised as the initial study modality when attempting to exclude retained foreign bodies. Most calcareous spines are visualized directly or indirectly with the use of plain radiographs.

Nonradiodense objects may be revealed as filling defects, or they may be outlined by air drawn into the wound during injury.

Ultrasound

If an object cannot be visualized by plain film radiography or retrieved easily through direct visualization, ultrasound may be used.

Ultrasound can detect nonradiodense foreign bodies as small as 1 mm by 2 mm, and it can be used to accurately localize foreign material and provide guidance during removal.

Tendons, deep scar tissue, fresh hematoma, and tissue calcifications can produce false-positive ultrasound readings.

Ultrasonography requires experience and skill to maximize its usefulness.

CT scanning and MRI

CT scanning and MRI, which can identify and precisely localize retained foreign material, are expensive alternatives to ultrasound.

Both imaging techniques require a high degree of patient cooperation and may be difficult to perform on pediatric patients.

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