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.
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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Lionfish (Pterois volitans) have long, slender spines with small venom glands, and they have the least potent sting of the Scorpaenidae family. Courtesy Dee Scarr.
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Scorpionfish (genus Scorpaena) have shorter, thicker spines with larger venom glands than lionfish do, and they have a more potent sting. Courtesy Dee Scarr.
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Stonefish (genus Synanceia) have short, stout spines with highly developed venom glands, and they have a potentially fatal sting. Courtesy Paul S. Auerbach, MD.
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Members of the genera Scorpaena, such as these scorpionfish, and Synanceia, such as the stonefish, usually are found well camouflaged on the sandy bottom of the sea or amongst rocks. Shoes or booties may provide some protection; however, it is best to avoid touching the sea bottom or to use a shuffling gait while wading. Courtesy Dee Scarr.
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Members of the genus Pterois, such as this lionfish, are usually free-swimming or hovering in small caves or crevices for protection. Provoking these fish by handling or cornering them may result in a painful envenomation. Courtesy Dee Scarr.
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In defense of the animals, envenomations and injury generally occur in response to a perceived threat, usually handling or stepping on the animals. Photo by Scott A Gallagher, MD.
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A 45-year-old diver was taking photographs in Australia at a depth of 60 feet. He suddenly noticed an excruciating pain in his left foot after resting his foot on a large stonefish. Photo courtesy John Williamson, MD and Surf Lifesaving Queensland.
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Top, Brown rockfish of the Scorpaenidae family. Lateral view of the left pelvic spine in articulation with the pelvic girdle. Middle, Anterior view of left pelvic spine (proximal portion) of the brown rockfish. Bottom, Lionfish spine.
