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Kawai Y, Ogawa O, Hirose Y. Point-of-Care Ultrasound for an Esophageal Foreign Body. J Emerg Med 2022; 63:e53-e56. [PMID: 35871027 DOI: 10.1016/j.jemermed.2022.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Press-through packs (PTPs) are widely used for storing drugs. The number of cases involving improper swallowing and esophageal foreign bodies (EFBs) has increased with the increasing use of PTPs. Studies have reported the utility of point-of-care ultrasound (POCUS) for evaluating EFBs. The application of POCUS for esophageal PTPs has not been reported. CASE REPORT An 83-year-old woman complaining of neck pain and odynophagia that occurred after improperly swallowing 2 PTPs was admitted to the emergency department. EFBs were suspected, and POCUS revealed a hyperechoic material, suggestive of a PTP, in the cervical esophagus. Endoscopy was immediately performed, and the PTPs were successfully removed without complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This study was significant because it documented the application of POCUS to detect esophageal PTPs. POCUS is a simple and noninvasive technique for identifying EFBs without radiation exposure. © 2022 Elsevier Inc.
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Affiliation(s)
- Yosuke Kawai
- Department of Emergency Medicine, Niigata Prefectural Central Hospital, Niigata, Japan.
| | - Osamu Ogawa
- Department of Emergency Medicine, Niigata Prefectural Central Hospital, Niigata, Japan.
| | - Yasuo Hirose
- Department of Emergency and Critical Care Medicine, Niigata City General Hospital, Niigata, Japan.
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Diaz-Tormo C, Rodriguez-Martinez E, Galarza L. Airway Ultrasound in Critically Ill Patients: A Narrative Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1317-1327. [PMID: 34427949 DOI: 10.1002/jum.15817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 06/13/2023]
Abstract
Airway assessment and management have a central role in critical care medicine. Airway ultrasound can help us evaluate the anatomy, facilitate interventions such as intubation in difficult airways and tracheostomy, prevent post-extubation complications, and diagnose dysphagia. In this review, we will summarize the current use of ultrasound in airway assessment and management in critically ill patients.
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Affiliation(s)
- Carmen Diaz-Tormo
- Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain
| | - Enver Rodriguez-Martinez
- Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain
| | - Laura Galarza
- Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain
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Affiliation(s)
- Yu-Te Su
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sy-Jou Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ling-Yuan Li
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Ahn JH, Sohn Y. Application of point-of-care ultrasound for different types of esophageal foreign bodies: three case reports: A CARE-compliant article. Medicine (Baltimore) 2020; 99:e18893. [PMID: 31977900 PMCID: PMC7004603 DOI: 10.1097/md.0000000000018893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RATIONALE Esophageal point-of-care ultrasound (POCUS) has recently been reported as a useful, quick, safe, and simple technique to detect esophageal foreign bodies (FBs). However, case series to detect esophageal FB using POCUS have been rarely reported. Chicken bones and pills, especially, have not yet been reported as esophageal FBs. The objective of this case series was to describe the POCUS findings of 3 different materials-food, pill, and chicken bone. PATIENT CONCERNS Case 1, a 75-year-old woman with odynophagia and neck pain occurring 30 min after eating chicken porridge; Case 2, a 32-year-old woman with neck discomfort occurring 2 h after taking a pill; Case 3, a 29-year-old woman reporting FB sensation in the neck that occurred 1 h after eating sausage and rice soup. DIAGNOSIS Case 1. Cervical esophageal FB (chicken bone), Case 2. Cervical esophageal FB (oral pill), Case 3. Cervical esophageal FB (food). INTERVENTIONS Case 1. POCUS, urgent esophagogastroduodenoscopy (EGD) with alligator forceps. POCUS findings; hyperechoic material (suspected FB) that did not disappear by swallowing and esophageal dilatation with pooling of secretions. Case 2. POCUS. POCUS findings; hypoechoic material (suspected FB) that did not disappear by swallowing, and esophageal bulging above the FB, especially observed in the longitudinal view. Case 3. POCUS. POCUS findings; hyperechoic material (suspected FB) with reverberation artifact that did not disappear with swallowing efforts. Prior FB esophageal bulging with persistent air-fluid level was especially observed in the longitudinal view. OUTCOMES Case 1. FB was removed by EGD with alligator forceps. Case 2. Symptoms disappeared under observation without EGD. Follow-up POCUS revealed normalized bulging esophagus. Case 3. These symptoms improved after vomiting a large piece of food material. Three patients were discharged without complications. LESSONS In this case series, the impacted materials were chicken bone, pill, and food. However, POCUS findings were similar (esophageal dilation, hyperechoic or hypoechoic lesion with mixed echogenic contents in food or secretion, and no change with swallowing efforts). A longitudinal view was useful to assume the presence of cervical esophageal FB in all three cases. Thus, POCUS findings could be indirect signs of a FB in the esophagus.
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Affiliation(s)
- Jung Hwan Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon
| | - Youdong Sohn
- Department of Emergency Medicine, Seoul Metropolitan Government – Seoul National University Boramae Medical Center, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Emergency Medicine, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, UAE
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Long B, Koyfman A, Gottlieb M. Esophageal Foreign Bodies and Obstruction in the Emergency Department Setting: An Evidence-Based Review. J Emerg Med 2019; 56:499-511. [PMID: 30910368 DOI: 10.1016/j.jemermed.2019.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with esophageal foreign bodies or food bolus impaction may present to the emergency department with symptoms ranging from mild discomfort to severe distress. There is a dearth of emergency medicine-focused literature concerning these conditions. OBJECTIVE OF THE REVIEW This narrative review provides evidence-based recommendations for the assessment and management of patients with esophageal foreign bodies and food bolus impactions. DISCUSSION Esophageal foreign bodies and food bolus impaction are common but typically pass spontaneously; however, complete obstruction can lead to inability to tolerate secretions, airway compromise, and death. Pediatric patients are the most common population affected, while in adults, edentulous patients are at greatest risk. Foreign body obstruction and food bolus impaction typically occur at sites of narrowing due to underlying esophageal pathology. Diagnosis is based on history and examination, with most patients presenting with choking/gagging, vomiting, and dysphagia/odynophagia. The preferred test is a plain chest radiograph, although this is not required if the clinician suspects non-bony food bolus with no suspicion of perforation. Computed tomography is recommended if radiograph is limited or there are concerns for perforation. Management requires initial assessment of the patient's airway. Medications evaluated include effervescent agents, glucagon, calcium channel blockers, benzodiazepines, nitrates, and others, but their efficacy is poor. Before administration, shared decision making with the patient is recommended. Endoscopy is the intervention of choice, and medications should not delay endoscopy. Early endoscopy for complete obstruction is associated with improved outcomes. CONCLUSIONS This review provides evidence-based recommendations concerning these conditions, focusing on evaluation and management.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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Grebe LS, Wolf G, Schick B. [Sonographic analysis of swallowing in the cervical section of the esophagus]. HNO 2018; 67:45-50. [PMID: 30402811 DOI: 10.1007/s00106-018-0574-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dysphagia is a common symptom reported by patients in various medical fields, raising the question of diagnosis. In addition to otorhinolaryngologic examination with a mirror, the current gold standards videofluoroscopy and fiber optic endoscopic evaluation of swallowing (FEES) are available. Ultrasound is frequently used in everyday clinical practice, although its application for swallowing diagnostics needs addressing. MATERIALS AND METHODS Between April 2012 and February 2014, 81 subjects (age 19-66 years) with no indication of a swallowing disorder were sonographically examined. The anatomic representation of swallowing structures was evaluated and videos of the cervical part of the esophagus during swallowing of different consistencies (saliva, water, jelly) were recorded and analyzed. In a pilot study, the examination was tested on 3 dysphagia patients. RESULTS The base of the tongue, the intralaryngeal structures, the cervical spine, and the thyroid glands were well visualized. Sonographic representation of the cervical esophagus section was particularly successful. Its length could be detected at 5.78 ± 1.66 cm, the diameter measured at 0.88 ± 0.10 cm. Sonographic inspection of the sinus piriformis was most difficult; it could not be seen in 39.5% of cases. Visualization of the sinus piriformis was better in cases of normal weight and age <25 years (odds ratios 5.6 and 11.3, respectively). In the examination of patients with a swallowing disorder, three different pathologies (Forestier's disease, esophageal stenosis, and motor neuron disease) were identified as the cause of complaints. CONCLUSION Sonography enables very good visualization of swallowing and evaluation of the cervical esophagus. Where available, the otorhinolaryngologist should consider ultrasound as a diagnostic option, as it enables repeated evaluation of swallowing and can complement previously available diagnostic tools.
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Affiliation(s)
- Laura S Grebe
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Deutschland.
| | - G Wolf
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Deutschland
| | - B Schick
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Deutschland
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Mori T, Ihara T, Hagiwara Y. Pediatric food impaction detected through point-of-care ultrasonography. Clin Exp Emerg Med 2018; 5:135-137. [PMID: 29973037 PMCID: PMC6039366 DOI: 10.15441/ceem.17.236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/09/2017] [Indexed: 12/14/2022] Open
Abstract
A previously healthy 1-year-old boy suddenly began coughing while eating a dried sweet potato. Because he continued gagging after vomiting a piece of the dried sweet potato, his mother brought him to our emergency room. Upon arrival, despite normal pulmonary findings, he was drooling and gagging. Ultrasonography was performed because food impaction at the upper esophagus was suspected based on his medical history and physical examination, and results showed that a linear hyperechoic lesion was obstructing the posterior esophageal wall. Computed tomography was also considered for a detailed examination of the foreign body. However, the patient vomited the dried sweet potato before the test was performed. After vomiting the foreign body, the patient stopped gagging, and his ultrasonographic findings were normal. Therefore, the patient was discharged without any complications.
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Affiliation(s)
- Takaaki Mori
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Takateru Ihara
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yusuke Hagiwara
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Shi WS, Su ZY, Wei CY, Chen XF, Liu SS, Fu X, Liu DL, Cui GH. Clinical features and standardized diagnosis and treatment of esophageal foreign bodies. Shijie Huaren Xiaohua Zazhi 2017; 25:2721-2730. [DOI: 10.11569/wcjd.v25.i30.2721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To summarize the clinical characteristics of esophageal foreign bodies and to explore their standardized diagnosis and treatment.
METHODS This retrospective study was conducted at our hospital from July 2011 to July 2017, and we reviewed the clinical data for 1190 patients with esophageal foreign bodies with regard to their sex, age, department patients first visited, treatment time, type, incarcerated site, treatment plan, and length of hospital stay.
RESULTS Of 1190 patients included, 568 were male and 622 were female, with a male-to-female ratio of 1.0:1.1. They aged from 2 mo to 99 years (mean, 45 years ± 28.44 years), with a median age of 54 years; 293 (24.6%) patients were under 15 years, 293 (24.6%) were between 15 and 55 years, and 604 (50.8%) over 55 years. Otolaryngology and head surgery department was the most first-visited department (966, 81.2%), followed by gastroenterology department (138, 11.6%), thoracic surgery department (46, 3.4%), and others (40, 3.4%). There were 716 (60.2%) patients who visited hospital within 24 h, 126 (10.6%) in 24 to 72 h, and 348 (29.2%) over 72 h. The foreign bodies were plant-based in 448 (37.6%) patients, animal-based in 403 (33.9%), metallic in 200 (16.8%), and composite material-based in 139 (11.7%), with jujube pits, chicken bones, and coins accounting for 62.9% (750 patients) of all cases. The foreign bodies were most commonly located in the upper orifice of the esophagus (827, 69.5%), followed by the upper part (245, 20.6%), the middle and lower parts (94, 7.8%), and others (25, 2.1%). We treated 1088 (91.4%) patients by endoscopy and 41 (3.4%) by surgery. The duration of hospitalization ranged from 1 to 71 d (median, 5 d; mean, 5.9 d ± 4.9 d).
CONCLUSION Esophageal foreign bodies most commonly occur in the upper orifice of the esophagus. Standardized diagnosis and treatment are important. Esophageal foreign bodies should be taken out within 24 h. Timely correction of water and electrolyte disturbance, effective antibiotic therapy, high nutrition support, and temporary esophageal, if necessary, are beneficial to the patient's recovery.
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Affiliation(s)
- Wen-Song Shi
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Zheng-Yan Su
- Department of Gastroenterology, General Hospital of Tianjin Medical University, Tianjin 300000, China
| | - Chuang-Ye Wei
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Xiao-Fang Chen
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Shuai-Shuai Liu
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Xiao Fu
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
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