Radiographic diagnosis of foreign bodies in the oesophagus

Abstract

In a group of patients suspected of harbouring a foreign body in the oesophagus, the diagnostic accuracy of radiographic examination is found to be high. Only 1 of 243 patients examined by radiography presented a false negative result.

Analysing lateral soft tissue neck radiographs

“…As a high proportion of foreign bodies are in the oropharynx typically in the tonsil, base of tongue or vallecula and lateral soft tissue neck X-rays have poor sensitivities to locate these, a radiograph should only be requested after a thorough examination of the oral cavity and oropharynx [11,25,31,32]. If the radiograph and examination are normal, this does not exclude the presence of a foreign body [6][7][8][9][10][11][12][13]. The patient should receive the benefit of the doubt if a good history is given [7][8][9].…”

“…For situations where diligent history and examination have indicated the foreign body is lower down, an X-ray should be performed, with sensitivities of 25-99% and specificities ranging from 45% to 86% reported [8][9][10][11][12][13]. Nandhi and Ong found that bones most commonly impact at the level of cricopharyngeus (75%) [2,20,21].…”

“…Although lateral X-rays help to ascertain the diagnosis, further radiological imaging is required in the form of CT as it provides more precise anatomical delineation vital for confirming an abscess, the extent of infection and for surgical planning [14][15][16]. Lateral neck radiographs are useful investigations in the acute setting for the diagnosis of foreign bodies and retropharyngeal abscesses [13,15]. In paediatric emergency departments, the primary management of acute laryngotracheobronchitis (croup) and epiglottitis focuses on securing the airway.…”

“…A thorough history and examination remains the cornerstone to managing the patient appropriately. A lateral soft tissue neck radiograph is a cheap, readily available investigation tool that is of clinical value in assessing patients with potential pathology of the upper aerodigestive tract [1,2,[6][7][8][9][10][11][12][13].…”

“…In the emergency department, these radiographs are useful in the assessment of foreign bodies in the hypopharynx and upper cervical oesophagus with some series elucidating sensitivities of over 80% [6][7][8][9][10][11][12][13]. They have no clinical value for foreign bodies in the oral cavity or oropharynx [11].…”