The utility of repeated computed tomography to track a foreign body penetrating the esophagus to the level of the thyroid gland

Abstract

ObjectiveForeign body (FB) ingestion is a common problem in otolaryngology. One uncommon complication of FB ingestion is penetration to the level of the thyroid gland. To our knowledge, only 21 such cases have been reported in the literature. Here, we report a case of an esophageal FB penetrating to the level of the right thyroid gland.Case reportThe patient was a 38-year-old woman in whom an esophageal FB penetrated to the level of the right thyroid gland. We traced the path to the thyroid gland using repeated computed tomography (CT) scans and demonstrated the importance of multiplanar reconstruction in locating the FB and formulating a precise surgical plan.ConclusionsTo our knowledge, this is the first report of repeat CT scans being used to demonstrate the migratory route, over time, of a FB penetrating through the esophagus to the level of the thyroid gland. Our results suggest that multiplanar reconstruction may play a key role in the precise diagnosis of a FB at the level of the thyroid gland and may help surgeons choose the best approach for removal.

Airway Complications from an Esophageal Foreign Body

“…When ingestion of a foreign body is suspected, either by symptoms, when present, or by clinical history imaging studies with X-ray of neck, chest, and abdomen may help in diagnosis [17]. We performed an X-ray with lateral view of the neck and no radiopaque foreign body was seen in the pharyngeal or laryngeal region, as literature suggests [18, 19]. In the event of the negative X-ray and patient with a high index of suspicion for FBI, we performed a chest computerized tomography as our next step for diagnosis, which reported the presence of a mass posterior to the trachea, as mentioned above.…”

“…Other life treating complications are airway compromise as occurred in our patient, which was treated initially by endotracheal intubation and later endoscopic removal of the FBI. Other complications from FBI are direct damage to the esophageal wall and migration of foreign body to trachea or mediastinum [6, 18]. …”

Una espina en un pajar: espina de pescado alojada en la tiroides

“…Estos autores informaron sobre un cuerpo extraño que migró de la orofaringe a la glándula tiroides 1,5,6 . Esta localización final es aún más extraña debido a las estructuras anatómicas que se interponen y se cuenta con pocos casos reportados 7 . Como consecuencia, es posible que se formen abscesos tiroideos, más comúnmente en la población pediátrica, y su aparición está directamente relacionada con el tiempo que el cuerpo extraño permanezca alojado en el esófago.…”

“…El mecanismo exacto de la migración se desconoce, pero se cree que se relaciona con el peristaltismo del esófago, el movimiento del cuello y las características físicas de las espinas de pescado, ya que su estructura es fina, lineal y filosa (figura 1), lo cual les permiten atravesar fácilmente la mucosa con la fuerza que los músculos alrededor ejercen sobre ellas e, incluso, llegan a migrar fuera de la luz esofágica en horas, lo cual aumenta el riesgo para el paciente 1,7 .…”

“…Las complicaciones por un cuerpo extraño son infrecuentes, pero su morbilidad y mortalidad son importantes 2,4,7 . Antes de la era de los antibióticos, la mortalidad llegaba incluso al 45 % 1 .…”