Fish bone foreign bodies in the pharynx and upper esophagus: evaluation with 64-slice MDCT

Abstract

MDCT is useful for the evaluation of the pharynx and upper esophageal FB foreign bodies.

Diagnosing Fish Bone and Chicken Bone Impactions in the Emergency Department Setting

“…Based on the results of this study and the reported sensitivity of MDCTs, 9 we hypothesize that a low-dose radiation protocol MDCT would serve as a highly sensitive screening tool and obviate the need for further imaging studies, direct visualization, and the associated time delay and cost.…”

“…In a review of 4 small prospective, nonrandomized studies comparing plain radiographs to CT, CT had a sensitivity of 100% in all 4 studies and there was just 1 false positive in all 80 patients pooled from the studies. 8 In a recent study by Park et al, 9 64-slice multidetector computed tomography (MDCT) demonstrated 100% sensitivity among 66 patients, versus 51.7% among plain radiographs. With this apparent superiority in mind, the clinician must balance the associated time, cost, and radiation of CT against the poor performance of clinical evaluation and plain radiographs.…”

Proposal for methods of diagnosis of fish bone foreign body in the Esophagus

“…Among gastrointestinal foreign bodies, 80% to 90% pass spontaneously. Among those, fewer than 1% require surgery . However, when the foreign body is in the esophagus, diagnosis and treatment are not easy.…”

“…In the hospital, physical examinations and radiographic tests (cervical plain films) are usually performed. The palatine tonsils are known as common impaction sites , and when the foreign body is in the oral cavity or laryngopharynx, it can be easily discovered and removed . When the foreign body is located in the esophagus or embedded in the esophageal wall, however, it is not easy to detect and remove.…”

Usual suspects: the foreign bodies of the aerodigestive tract

“…Reported cases of extraluminally migrated fish bone foreign bodies were found to have transverse orientation at the site of lodgement 10 11. Though the patient in case 3 had successfully extruded impacted fish bone from the pharynx by self-induced gagging, the authors discourage such an approach as the majority of fish bones in pharynx would have the transverse orientation, unlike the favourable situation in this case 12. Moreover, the fish bones impacted transversely are likely to be missed by plain radiographs compared with the ones impacted vertically 13…”