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Bottom line: Start with X-ray to evaluate for retained stingray barb fragments. Remove foreign bodies with surgical consult as necessary.
Stingrays strikes represent one of the most common human envenomations from marine animals. Venom from these barbs causes immediate local pain and less commonly may cause a variety of systemic symptoms. Rarely are these primary effects life-threatening. A secondary risk, retained barb fragments can lead to complicated infections. Identification of retained fragments for removal is key. This study compared three radiology modalities on cadaveric limbs.
X-ray was associated with the highest sensitivity of 94% for the identification of a retained barb, followed by MRI (83%) and ultrasound (70%). MRI was associated with the highest specificity of 100%, followed by x-ray (98%) and ultrasound (73%).
Consideration must be given to individual sonographer skill level and difficulty variable with regional anatomy. Full article below is worth a look for comparison of images.
References
Docter TA, Altschuh LB, Medak AJ, Statum SM, Chung CB, Van Hoesen KB, Coffey CH. Comparison of Radiographic, Ultrasound, and Magnetic Resonance Imaging for the Detection of Retained Stingray Barb: A Cadaveric Study. Wilderness Environ Med. 2021 Sep;32(3):302-307. doi: 10.1016/j.wem.2021.03.012. Epub 2021 Jul 20. PMID: 34294537.