Imaging Pearls ❯ Esophagus ❯ Foreign Body
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- “However, a small fraction of FBs in the esophagus cannot be detected readily by traditional approaches, such as plain films of the neck and chest, barium swallowing, and direct esophagoscopic examinations. A plain cervical x-ray typically has poor sensitivity when the FB is a fish or chicken bone, because these are rarely visible on radiographs. A plain radiograph is only suitable for searching for more radiodense FBs. If prompt diagnosis of FBs is not established, serious complications with high risks of morbidity and mortality can result, such as periesophagitis, periesophageal abscess, mediastinitis, aortoesophageal fistula, innominate esophageal fistula, and carotid rupture.”
Value of helical computed tomography in the early diagnosis of esophageal foreign bodies in adults
Yong-Cai Liu et al.
The American Journal of Emergency Medicine, Volume 31, Issue 9, 2013,Pages 1328-1332 - "Many studies have considered computed tomography diagnoses of esophageal FBs. CT scanning appears to be sensitive and specific for the investigation of patients with an ingested FB. CT can provide valuable information not only about the presence of an FB, but also about its precise location and the condition of surrounding structures and soft tissues.”
Value of helical computed tomography in the early diagnosis of esophageal foreign bodies in adults
Yong-Cai Liu et al.
The American Journal of Emergency Medicine, Volume 31, Issue 9, 2013,Pages 1328-1332 - "With the rapid development and spread of CT technology, increasing numbers of studies have reported the successful use of CT in cases of impacted FBs, and its advantages have been recognized gradually over recent years . We found CT scanning to be very effective for detecting esophageal FBs in this study. CT demonstrated 100% sensitivity, 92.6% specificity, 100% negative predictive value, and 97.9% positive predictive value. Our findings are consistent with other reports that have suggested that CT results are reliable and trustworthy for detecting FBs.”
Value of helical computed tomography in the early diagnosis of esophageal foreign bodies in adults
Yong-Cai Liu et al.
The American Journal of Emergency Medicine, Volume 31, Issue 9, 2013,Pages 1328-1332 - "Impacted FBs in the esophagus can easily cause mucosal injuries, including ulceration, inflammation, and erosions. If not promptly and properly treated, FBs impacted in the esophagus for a long time are prone to result in esophageal perforation, and that may lead to other secondary complications and potentially life-threatening complications, such as cervical and mediastinal abscess, mediastinitis, retropharyngeal hematoma, or even aortoesophageal fistula. Because early diagnosis and prompt removal of FBs are key factors for avoiding complications, we need a fast and accurate diagnostic strategy for detecting FBs.”
Value of helical computed tomography in the early diagnosis of esophageal foreign bodies in adults
Yong-Cai Liu et al.
The American Journal of Emergency Medicine, Volume 31, Issue 9, 2013,Pages 1328-1332 - Steakhouse Syndrome
- “Fish bone is one of the most common accidentally ingested foreign bodies, and patients commonly present to the emergency department with nonspecific symptoms. Fortunately, most of them are asymptomatic and exit the gastrointestinal tract spontaneously. However, fish bones can get impacted in any part of the aerodigestive tract and cause symptoms. Occasionally, they are asymptomatic initially after ingestion and may present remotely at a later date with serious complications such as gastrointestinal tract perforation, obstruction, and abscess formation.”
CT findings of accidental fish bone ingestion and its complications Venkatesh SH et al. Diagn Interv Radiol. 2016 Mar; 22(2): 156–160. - “The most common site of impaction in the esophagus is within the cervical portion, mostly within the cricopharyngeus muscle at C5/C6 level . The other sites of impaction within the esophagus are at the level of aortic arch, gastroesophageal junction, where normal extrinsic impression or anatomical narrowing is expected . Such patients with fish bone impaction in the pharynx and esophagus usually present with symptoms like foreign body sensation, pain, and swelling. Hence, diagnosis, especially by CT scan, is not very difficult as definitive clinical history is usually present.”
CT findings of accidental fish bone ingestion and its complications Venkatesh SH et al. Diagn Interv Radiol. 2016 Mar; 22(2): 156–160. - “Fish bone impaction at these sites can be complicated by esophageal perforation, bleeding, hematoma, and abscess formation. Rarely, fistulation into the adjacent trachea or great vessels can be seen. Thin wall, lack of adventitia, and relatively poor vascularity of the esophagus makes it more susceptible to perforation and necrosis.”
CT findings of accidental fish bone ingestion and its complications Venkatesh SH et al. Diagn Interv Radiol. 2016 Mar; 22(2): 156–160. - “Fish bone perforations can occasionally simulate malignancy and other acute and chronic inflammatory processes. This is commonly due to significant inflammatory thickening or mass-like appearance of the involved structures, lack of background history of fish bone ingestion and unfamiliarity with varied imaging appearance of the fish bones. CT is highly sensitive, and a definitive diagnosis can be established by identification of the fish bone. Careful attention to technical factors like thin slice thickness [1.5–2 mm], presence of negative bowel contrast and evaluation of reformats in multiple planes can aid accurate diagnosis..”
CT findings of accidental fish bone ingestion and its complications Venkatesh SH et al. Diagn Interv Radiol. 2016 Mar; 22(2): 156–160. - “Familiarity with various imaging features and relevant clinical history can establish the diagnosis of accidental fish bone ingestion. CT with its multiplanar capability is highly valuable to diagnose and accurately localize the ingested fish bone. In addition, CT can also provide a comprehensive evaluation of the complications of fish bone ingestion including those that may be seen remote from the site of bowel perforation.”
CT findings of accidental fish bone ingestion and its complications Venkatesh SH et al. Diagn Interv Radiol. 2016 Mar; 22(2): 156–160. - In adults, foreign body impactions are mostly seen in the context of a pre-existing pathology
• Strictures (about 37%)
• Malignancy (about 10%)
• Esophageal rings (about 6%)
• Achalasia (about 2% of cases) - Eosinophilic esophagitis, which has a secondary role in foreign body impaction, has been described in up to 33% of cases of bolus impaction. However, in some cases no pathological predisposition is present. Furthermore, more cases of ingested foreign bodies are reported in patients of advanced age, those with mental retardation, and with psychiatric disorders. The physiologically and anatomically narrow parts of the gastrointestinal tract make the passage of the ingested body difficult and are predilected sites for foreign body impaction
- The range of indications for endoscopy should be extensive; bolus impaction with complete occlusion of the esophagus, sharp/pointed foreign bodies, and batteries constitute indications for emergency esophagogastroduodenoscopy, magnets and long (>6 cm) foreign bodies should be removed within 24 hours.
In the overwhelming majority of patients the ingested body passes without any problems; endoscopic intervention is required in 20% of cases and surgical intervention in less than 1% of cases.