1
|
Oruqaj G, Krombach G, Gattenloehner S, Herold S, Vadász I, Seeger W, Tello K, Hecker M. Adenomatous hyperplasia induced by chronic cherry pit retention mimicking an endobronchial tumor-case series and systematic review of literature. Front Med (Lausanne) 2024; 11:1404951. [PMID: 39086956 PMCID: PMC11288952 DOI: 10.3389/fmed.2024.1404951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Endobronchial foreign body aspiration is not common in adults, but it is a life-threatening event. Recurrent pneumonias by chronic retention of foreign body often lead to initial medical presentation of the patient. However, lymphoplasmacellular bronchitis with adenomatous hyperplasia and squamous epithelium metaplasia with complete or partial blockage of lobar bronchus mimicking lung tumor is rare in literature, and this particular condition is often misdiagnosed. Case presentation we report our experience in the diagnostic and management of two elderly patients with recurrent pneumonia, admitted in hospital for further examination. In both patients, with no history of aspiration, the cherry pit was detected during bronchoscopy and recanalization with flexible cryoprobe, surrounded by purulent secretion, occluding completely the right upper lobe in the first case, and partially the left lower lobe associated with persistent actinomycosis in the second case, with signs of local inflammation, bronchial adenomatous hyperplasia mimicking lung tumor at initial bronchoscopic examination. Histology showed a lymphoplasmacellullar bronchitis with adenomatous hyperplasia and squamous epithelium metaplasia because of chronic retention of foreign body. Conclusion Bronchoscopy examination should be considered in cases where there is an unresolved chronic cough with recurrent pneumonia or persistent actinomycosis in patients with high risk. Cryoprobe is a safe and feasible approach for treatment of airway obstructions due to chronic foreign body retention. Furthermore, relevant findings are discussed here, along with a review of the pathologic alterations and treatment modalities seen in chronic retention of foreign body and airway injury.
Collapse
Affiliation(s)
- Gani Oruqaj
- Department of Internal Medicine, Medical Clinic II, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Gabriele Krombach
- Department of Radiology, University Hospital Giessen, Giessen, Germany
| | - Stefan Gattenloehner
- Department of Pathology, Justus-Liebig- University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Susanne Herold
- Department of Internal Medicine V, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - István Vadász
- Department of Internal Medicine, Medical Clinic II, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine, Medical Clinic II, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Khodr Tello
- Department of Internal Medicine, Medical Clinic II, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Matthias Hecker
- Department of Internal Medicine, Medical Clinic II, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| |
Collapse
|
2
|
Zhang Y, Liang ZR, Xiao Y, Li YS, Fu BJ, Chu ZG. CT Characteristics and Clinical Findings of Bronchopneumonia Caused by Pepper Aspiration. Int J Gen Med 2024; 17:2757-2766. [PMID: 38895049 PMCID: PMC11184221 DOI: 10.2147/ijgm.s464076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose To explore the computed tomography (CT) features of bronchopneumonia caused by pepper aspiration to improve the diagnosis. Materials and Methods 28 adult patients diagnosed with obstructive pneumonia caused by pepper aspiration from January 2016 to September 2022 were enrolled. The CT characteristics of bronchial changes and pulmonary lesions caused by pepper were analyzed and summarized. Results Among 28 patients, the most common symptom was cough (26, 92.9%), followed by expectoration (23, 82.1%). Bronchoscopy revealed that peppers were mainly found in the bronchus of the right lower lobe (n = 18, 64.3%), followed by the bronchus of the left lower lobe (n = 5, 17.9%). In combination with bronchoscopy results, the pepper in the bronchus manifested as circular or V/U-shaped high-density, localized soft tissue, and flocculent opacification in 8 (28.6%), 16 (57.1%), and 3 (10.7%) cases on CT images, respectively. The bronchial wall around the pepper was thickened with localized occlusion (n = 19, 67.9%) and stenosis (n = 9, 32.1%). Regarding adjacent bronchi without peppers, extensive wall thickening with stenosis and/or occlusion was found in 23 (82.1%) cases. Distal pulmonary lesions frequently involved two or three segments (21, 75.0%) and mainly presented as patchy consolidation or atelectasis (24, 85.7%). Conclusion In combination to a history of eating peppers and clinical symptoms, bronchopneumonia caused by pepper should be highly suspected if U/V-shaped and annular high-density or localized soft tissue density is detected in the bronchi of the lower lobes, accompanied by extensive bronchial wall thickening, stenosis, or occlusion, and consolidation or atelectasis in multiple distal lung segments.
Collapse
Affiliation(s)
- Yi Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Department of Radiology, Chongqing Jiangjin Second People’s Hospital, Chongqing Jiangjin Cancer Hospital, Chongqing, 402260, People’s Republic of China
| | - Zhang-Rui Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
| | - Yang Xiao
- Department of Respiratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Yi-Shi Li
- Department of Respiratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| |
Collapse
|
3
|
Eibschutz L, Lu MY, Abbassi MT, Gholamrezanezhad A. Artificial intelligence in the detection of non-biological materials. Emerg Radiol 2024; 31:391-403. [PMID: 38530436 PMCID: PMC11130001 DOI: 10.1007/s10140-024-02222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
Artificial Intelligence (AI) has emerged as a transformative force within medical imaging, making significant strides within emergency radiology. Presently, there is a strong reliance on radiologists to accurately diagnose and characterize foreign bodies in a timely fashion, a task that can be readily augmented with AI tools. This article will first explore the most common clinical scenarios involving foreign bodies, such as retained surgical instruments, open and penetrating injuries, catheter and tube malposition, and foreign body ingestion and aspiration. By initially exploring the existing imaging techniques employed for diagnosing these conditions, the potential role of AI in detecting non-biological materials can be better elucidated. Yet, the heterogeneous nature of foreign bodies and limited data availability complicates the development of computer-aided detection models. Despite these challenges, integrating AI can potentially decrease radiologist workload, enhance diagnostic accuracy, and improve patient outcomes.
Collapse
Affiliation(s)
- Liesl Eibschutz
- Department of Radiology Division of Emergency Radiology, Keck School of Medicine, University of Southern California (USC), 1500 San Pablo Street, Los Angeles, CA, 90033, USA
| | - Max Yang Lu
- Department of Radiology Division of Emergency Radiology, Keck School of Medicine, University of Southern California (USC), 1500 San Pablo Street, Los Angeles, CA, 90033, USA
| | - Mashya T Abbassi
- Department of Radiology Division of Emergency Radiology, Keck School of Medicine, University of Southern California (USC), 1500 San Pablo Street, Los Angeles, CA, 90033, USA
| | - Ali Gholamrezanezhad
- Department of Radiology Division of Emergency Radiology, Keck School of Medicine, University of Southern California (USC), 1500 San Pablo Street, Los Angeles, CA, 90033, USA.
| |
Collapse
|
4
|
Guerra PV, Anderson K, Clausen SM, Carr MM. Laryngeal Foreign Body Aspiration in Infancy: A Diagnostic Challenge. Cureus 2024; 16:e60144. [PMID: 38864055 PMCID: PMC11166228 DOI: 10.7759/cureus.60144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 06/13/2024] Open
Abstract
Foreign body aspiration (FBA) is a significant cause of accidental death among children, with laryngeal FBA being relatively rare but potentially fatal due to airway obstruction. This report highlights a case of laryngeal FBA in an 11-month-old child, initially misdiagnosed as viral croup. Otolaryngological evaluation, particularly in the case of laryngeal FBA, may facilitate management. An 11-month-old male was brought to the emergency department, presenting with inspiratory stridor following a choking episode. A chest radiograph and CT scan of the chest were read as normal. He was suspected of having croup and treated with dexamethasone and racemic nebulized epinephrine, which led to temporary clinical improvement. The child returned with persistent stridor to the emergency department eight days after his initial visit, prompting an otolaryngological consultation. Flexible laryngoscopy ultimately identified a star-shaped sequin lodged in the glottis. The foreign body was successfully removed via direct laryngoscopy and bronchoscopy (DLB). Following the removal, the patient demonstrated significant improvement and eventually made a full recovery. This case emphasizes the difficulty in diagnosing laryngeal FBA due to its non-specific symptoms and the limitations of imaging techniques. The importance of a thorough clinical history, physical examination, and proper imaging combined with a high index of suspicion is crucial for early diagnosis and treatment. Additionally, the report discusses the potential for severe complications if diagnosis and treatment are delayed, highlighting the need for awareness and prompt intervention in suspected laryngeal FBA cases.
Collapse
Affiliation(s)
- Paula V Guerra
- Otolaryngology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Kelvin Anderson
- Otolaryngology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Sean M Clausen
- Otolaryngology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Michele M Carr
- Otolaryngology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| |
Collapse
|
5
|
Georgakopoulou VE, Tarantinos K, Mermigkis D. Foreign Body in the Tracheobronchial Tree as a Cause of Hemoptysis in an Adult Without Risk Factors for Aspiration: A Case Report. Cureus 2024; 16:e57596. [PMID: 38707010 PMCID: PMC11069630 DOI: 10.7759/cureus.57596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Although aspiration of a foreign body into the trachea and bronchi can occur in all age groups, it is more common in infants and young children. Foreign bodies in the tracheobronchial tree are uncommon in adults and mainly present in patients with dysphagia and an altered level of consciousness. The identification of foreign bodies in the tracheobronchial tree is frequently overlooked or delayed, leading patients to present later with chronic symptoms and potential complications. These complications may include persistent coughing, wheezing, obstructive pneumonitis, bronchiectasis, and abscess formation secondary to recurrent pulmonary infections. This article aims to present the case of a 27-year-old patient without risk factors for aspiration who has experienced recurrent self-limiting hemoptysis episodes for five years. Bronchoscopy revealed a foreign body at the entrance to the middle lobe bronchus. The presence of a foreign body in the tracheobronchial tree should be considered in any patient with recurrent hemoptysis. Bronchoscopy leads to accurate diagnosis, treatment, and prevention of complications.
Collapse
|
6
|
Doppalapudi S, Fortuzi K, Qasim A, Yordanka DS, Khaja M. Glass in the Airways: A Bronchoscopic Challenge. Cureus 2024; 16:e53344. [PMID: 38435889 PMCID: PMC10907552 DOI: 10.7759/cureus.53344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Foreign body aspiration (FBA) in adults is indeed a significant medical concern, albeit less common than in children. The increase in incidence with advancing age can be attributed to factors such as a decline in mental status and impairment of the swallowing reflex, which is more prevalent in the elderly population. The symptoms of FBA are highly variable, ranging from severe, acute asphyxiation, which may or may not involve complete airway obstruction, to more subtle signs like coughing, shortness of breath (dyspnea), choking, or fever. These varied presentations, coupled with the fact that many other medical conditions can mimic the respiratory symptoms seen in FBA, make diagnosis challenging. A high index of suspicion is often required, especially in cases where the patient's history does not clearly point toward aspiration. Immediate management focuses on supporting the airway, which is crucial given the potential for severe obstruction. Radiographic imaging plays a key role in localizing the foreign body, which is vital for planning its removal. Bronchoscopy, particularly flexible bronchoscopy, is the cornerstone of both diagnosis and treatment. This technique allows for direct visualization of the airways, localization of the foreign body, and its subsequent removal. This is crucial to avoid long-term complications, which can arise if the foreign body is not promptly and effectively removed. In this case report, we present a 64-year-old female patient who was found to have a foreign object positioned in the right lower lobe of the lungs that was removed via flexible bronchoscopy.
Collapse
Affiliation(s)
- Sai Doppalapudi
- Pulmonary and Critical Care Medicine, BronxCare Hospital, New York City, USA
| | - Ked Fortuzi
- Pulmonary Medicine, BronxCare Hospital, New York City, USA
| | - Abeer Qasim
- Internal Medicine, BronxCare Hospital, New York City, USA
| | | | | |
Collapse
|
7
|
Salman Önemli C. TWENTY CYLINDRICAL BATTERIES PROGRESSING IN THE ABDOMEN OF AN ADULT PATIENT. Gastroenterol Nurs 2024; 47:63-66. [PMID: 38150622 DOI: 10.1097/sga.0000000000000751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/01/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Canan Salman Önemli
- Canan Salman Önemli, MD, is an anesthesiology and reanimation specialist, Department of Anesthesiology and Reanimation, University of Health Sciences Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
8
|
Wu HY, Chong WS, Chang CJ. Man with odynophagia. Emerg Med J 2023; 41:59-66. [PMID: 38135448 DOI: 10.1136/emermed-2023-213091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Hsin-Yi Wu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wah Sheng Chong
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Jung Chang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
| |
Collapse
|
9
|
Alam M, Tajbakhsh A, Badkoobeh A, Jahri M, Golkar M, Taheri A, Baseri M. Facilitating the removal of a foreign body in the tongue by intraoperative ultrasound guidance: A case report. J Med Life 2023; 16:1153-1156. [PMID: 37900067 PMCID: PMC10600662 DOI: 10.25122/jml-2023-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/07/2023] [Indexed: 10/31/2023] Open
Abstract
The presence of soft tissue foreign bodies (FBs) presents a substantial concern due to their potential to induce both acute and chronic pain as well as tissue irritation. This case report documents the admission of a 25-year-old female with a history of bur fractures during endodontic treatment, accompanied by signs of infection. The clinical examination and radiographic assessment revealed an embedded foreign body within her tongue. The surgical procedure was informed by repeated ultrasound scans through the incision, facilitating precise targeting. Intraoperative ultrasound enables the accurate detection of submucosal foreign bodies in dynamic tissues like the tongue and facilitates focused and image-guided dissection, thereby decreasing surgical trauma to the delicate soft tissues.
Collapse
Affiliation(s)
- Mostafa Alam
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ardeshir Tajbakhsh
- Anesthesia Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ashkan Badkoobeh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Qom University of Medical Sciences, Qom, Iran
| | - Mohammad Jahri
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Golkar
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anita Taheri
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Baseri
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Gordeeva OM, Egorova AD, Chesalina YO, Gretcov EM, Semenova LA, Karpina NL, Sivokozov IV. [Difficult case of differential diagnosis of partial lung atelectasis. Case report]. TERAPEVT ARKH 2023; 95:248-254. [PMID: 37167147 DOI: 10.26442/00403660.2023.03.202074] [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: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
In December 2018 the patient over 60 years old sought medical help with complaints of persistent cough. Based on computed tomography data there were identified the sings (symptoms) of right lung lower lobe atelectasis. To run this patient diagnostics there were performed 6 bronchoscopies narrowed down by bronchi checks up only and described the right lung central cancer picture. At the same time the biopsy taken during one of the bronchoscopies appeared non informative. Fine needle biopsy of mediastinal lymph nodes and bronchial wall was performed twice: at Tomsk Cancer Research Institute (it was suspected B-cell lymphoma based on biopsy examination) and at The Loginov Moscow Clinical Scientific Center (signs of inflammation based on biopsy examination). The video-assisted thoracoscopy with lymph node dissection of the right lung root was performed in January 2020. As a surgical material analysis result reactive adenopathy was determined. Therefore, during more than 1 year of diagnostic research the genesis of right lung lower lobe atelectasis was not established. The patient was directed to Central Tuberculosis Research Institute for diagnosis verification. Based on clinical and radiological picture Central Tuberculosis Research Institute colleagues suspected a foreign body in the intermediate bronchus. During an endoscopic examination it was revealed stenosis, biopsies were performed, but the foreign body could not be identified. In the pathomorphological laboratory of Central Tuberculosis Research Institute there were conducted histological examination of the material after endobronchial cryobiopsy and rigid needle biopsy. Both gave an unexpected result: invasive mycosis of the bronchial wall. As a conclusion the decision was taken to apply antimycotic therapy on an outpatient basis. As a result, clear clinical and radiological positive dynamics was obtained. In these favorable conditions for endoscopic examination, it was performed vitally essential cryoextraction of foreign body. The foreign body turned out to be a fragment of a spongy bone of a centimeter size. These actions have let to unlock the right lung lower lobe.
Collapse
|
11
|
White JJ, Cambron JD, Gottlieb M, Long B. Evaluation and Management of Airway Foreign Bodies in the Emergency Department Setting. J Emerg Med 2023; 64:145-155. [PMID: 36806432 DOI: 10.1016/j.jemermed.2022.12.008] [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: 05/17/2022] [Revised: 11/03/2022] [Accepted: 12/13/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Airway foreign body can be a life-threatening issue in pediatric and adult patients, and the majority of these patients will first present to the emergency department. OBJECTIVE This article provides a narrative review of the diagnosis and management of airway foreign bodies for the emergency clinician. DISCUSSION Foreign bodies in the upper and lower airways are potentially life threatening. This affects all age groups but is more common in pediatric patients. A history of a witnessed ingestion or aspiration event should raise the clinical suspicion for an aspirated foreign body. Patients with upper-airway foreign bodies are more likely to present in respiratory distress when compared with lower-airway foreign bodies, which often present with more subtle signs. Stridor, drooling, and wheezing suggest respiratory distress, but the presenting clinical picture is often unclear and may only include a cough. Immediate intervention is required in the patient with hemodynamic instability or respiratory distress. Airway management including laryngoscopy, fiberoptic bronchoscopy, and cricothyrotomy may be needed in these patients, with the emphasis on removing the obstructing foreign body and securing the airway. Specialist consultation can assist in retrieving the foreign body and managing the airway. If the patient is stable, imaging and specialist consultation for potential operating room intervention should be considered. CONCLUSIONS An understanding of the presentation, evaluation, and management of the patient with an airway foreign body is essential for emergency clinicians.
Collapse
Affiliation(s)
- Joshua J White
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - John D Cambron
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| |
Collapse
|
12
|
Maenza N, Mascola M, Liu T. Identifying a Needle Foreign Body in the Neck With Point-of-Care Ultrasound. J Emerg Med 2022; 63:795-797. [PMID: 36283901 DOI: 10.1016/j.jemermed.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/24/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Nick Maenza
- Department of Emergency Medicine, Garnet Health Medical Center, Middletown, New York
| | - Michael Mascola
- Department of Emergency Medicine, Garnet Health Medical Center, Middletown, New York
| | - Thomas Liu
- Department of Emergency Medicine, Garnet Health Medical Center, Middletown, New York.
| |
Collapse
|
13
|
Chen YH, Shomorony A, Drusin MA, Pearlman AN. Consultations for Foreign Bodies in Aerodigestive Tract: Assessment of Diagnostic Modalities. Laryngoscope 2022; 133:1361-1366. [PMID: 37158266 DOI: 10.1002/lary.30339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/01/2022] [Accepted: 07/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate test characteristics of various diagnostic modalities in the workup of foreign body (FB) sensation in the aerodigestive tract. METHODS Database containing all inpatient otolaryngology consultations between 2008 and 2020 was used. Cases of FB sensation were identified by documented encounter diagnosis or hospital problem of FB or globus sensation. Variables including basic patient demographics, clinical presentations, diagnostic imaging modalities, procedures, and outpatient follow-up were collected. RESULTS One hundred and six patients were included in the study. A FB was visualized in 55 patients (52%) and removed in 52 patients (49%); 3 patients had a FB that was visualized initially but not found in the operating room. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 41%, 50%, 58%, and 33%, respectively, for X-ray (XR); 91%, 61%, 70%, and 87%, respectively, for computed tomography (CT). Sensitivity and NPV were 25% and 57%, respectively, for flexible fiberoptic laryngoscopy (FFL). Seventy-one of 106 patients (67%) underwent invasive interventions during their workup for FBs. Ten out of 11 (91%) chicken bones were found in the digestive tract compared to 7 out of 19 (37%) fishbones (p = 0.0046). CONCLUSION In patients with history of FB ingestion, CT may be more beneficial than XR as a screening tool for locating foreign bodies and guiding further management. FFL alone is inadequate for ruling out a FB in the aerodigestive tract given FB's high likelihood of being in the esophagus or buried in soft tissue or mucosa. LEVEL OF EVIDENCE 3 Laryngoscope, 133:1361-1366, 2023.
Collapse
Affiliation(s)
- Yu Han Chen
- Department of Otolaryngology‐Head and Neck Surgery Weill Cornell Medicine New York City New York USA
| | - Andre Shomorony
- Department of Otolaryngology‐Head and Neck Surgery Weill Cornell Medicine New York City New York USA
| | - Madeleine A. Drusin
- Department of Otolaryngology‐Head and Neck Surgery Weill Cornell Medicine New York City New York USA
| | - Aaron N. Pearlman
- Department of Otolaryngology‐Head and Neck Surgery Weill Cornell Medicine New York City New York USA
| |
Collapse
|
14
|
Huang CY, Chu SE, Chang CJ, Chiu YC, Chiang WC, Huei-Ming Ma M, Sun JT. Man with a Sore Throat. Ann Emerg Med 2022; 79:451-484. [DOI: 10.1016/j.annemergmed.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Indexed: 11/01/2022]
|
15
|
Zulhisham M, Shatriah I. An Unusual Case of a Post-Traumatic Retained Periorbital Foreign Body in a Child. Cureus 2022; 14:e22478. [PMID: 35371746 PMCID: PMC8943521 DOI: 10.7759/cureus.22478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/05/2022] Open
|
16
|
Çağlayan F, Yozgat İlbaş FN. Sonographic features of various dental materials and foreign bodies. Dentomaxillofac Radiol 2022; 51:20210182. [PMID: 34347525 PMCID: PMC8802696 DOI: 10.1259/dmfr.20210182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To reveal the sonographic characteristics of various foreign bodies and dental materials to aid diagnosis. METHODS AND MATERIALS 24 objects consisting of various dental materials and foreign bodies were included in the study. Objects were embedded in bovine gelatin. Images of the objects were obtained by conventional radiography and ultrasonography (USG). Opacities were evaluated by conventional radiography. Their visibility and posterior acoustic behaviors were examined by USG. In addition, the actual sizes of the objects and their dimensions measured by USG were compared. RESULTS All objects included in the study, including non-opaque ones, could be visualized by USG. When the posterior acoustic behavior of objects was examined, 15 of the objects (62.5%) caused posterior acoustic shadowing on USG. While 6 of the objects (25%) did not have any USG artifacts, 2 of them (8,3%) had comet tail artifact and 1 of them (4,2%) had reverberation artifact. There was no statistically significant difference between the actual dimensions of the objects and their dimensions measured by USG (p > 0,05). CONCLUSION USG is a very useful technique for imaging foreign bodies and dental materials, it can even show objects that cannot be seen in X-rays on in-vitro environment.
Collapse
Affiliation(s)
- Fatma Çağlayan
- Department of Oral Dental and Maxillofacial Radiology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Fatma Nur Yozgat İlbaş
- Department of Oral Dental and Maxillofacial Radiology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| |
Collapse
|
17
|
Khan A. Nearly missed laryngeal foreign body. J Am Coll Emerg Physicians Open 2022; 3:e12662. [PMID: 35112103 PMCID: PMC8783379 DOI: 10.1002/emp2.12662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/17/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022] Open
Abstract
Foreign body ingestion and aspiration can present as a life-threatening emergency in children. These foreign bodies are diagnosed based on history, physical exam, and focused radiography to reduce the risk of excessive radiation. We describe a case of a 3-year-old child who ingested magnetic beads and presented to the emergency department with no symptoms. On a single view x-ray of chest and abdomen, the magnetic beads were identified in the abdomen but a closer look at these single view x-rays raised a suspicion of additional foreign bodies in the larynx. A dedicated x-ray of the neck identified 2 more magnetic beads locked with each other on either side of the epiglottis. These laryngeal magnetic beads were nearly missed on initial x-rays, especially because the child had no symptoms of upper airway obstruction. This case report provides further evidence that in the evaluation of radiopaque foreign bodies in children we should strongly consider "nose to rectum" x-rays.
Collapse
Affiliation(s)
- Abdullah Khan
- Dignity Health ‐ St. Rose Dominican HospitalDepartment of Pediatric Emergency MedicineSiena Campus HospitalHendersonNevadaUSA
| |
Collapse
|
18
|
Thakur PS, Aggarwal D, Takkar B. Management of a misidentified and misnumbered intraocular glass foreign body with an endoscope in a case of endophthalmitis. BMJ Case Rep 2021; 14:e244569. [PMID: 34610955 PMCID: PMC8493899 DOI: 10.1136/bcr-2021-244569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/03/2022] Open
Abstract
An endoscope is a useful adjunct for the retinal surgeon to overcome haze of a compromised anterior segment. It allows early surgery in trauma and infections which translates to better results. Intraocular glass foreign body is a challenging condition, demanding highly skilled surgical expertise. We present endoscopic removal of an intraocular foreign glass body in a badly traumatised and infected eye. The surgical challenge was accentuated by an imaging misdiagnosis of 'twin metallic foreign bodies'.
Collapse
Affiliation(s)
- Pratima Singh Thakur
- Smt Kanuri Santhamma Centre for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - David Aggarwal
- Smt Kanuri Santhamma Centre for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Smt Kanuri Santhamma Centre for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health, and Economics Research (IHOPE) Centre, LV Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
19
|
Abstract
Abdominal pain represents 5% to 7% of all emergency department presentations. Many patients require imaging for diagnosis, and choosing the appropriate imaging modality is a crucial decision point. Modern medicine offers a fantastic array of options including abdominal radiograph, computed tomography, MRI, and ultrasonography, but the plethora of alternatives can be paralyzing. This article introduces the commonly available modalities, discusses the advantages and disadvantages, and presents current recommendations for commonly diagnosed conditions.
Collapse
|
20
|
Ultrasonography in soft-tissue foreign-body detection: a phantom study. Pol J Radiol 2021; 86:e496-e499. [PMID: 34567296 PMCID: PMC8449557 DOI: 10.5114/pjr.2021.108879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Foreign body implantation into the soft tissues, either in the early period or late period, is a common cause of emergency department admissions. Direct X-rays are preferred in the diagnosis of soft-tissue foreign-bodies. Herein, we aimed to analyse the detection rates of foreign bodies of various sizes placed in phantoms implanted into soft tissue by ultrasonography. Material and methods A total of 740 pieces of chicken fillet were prepared as phantoms. No objects were implanted into 100 phantoms. We inserted glass, porcelain, plastic, wood, pencil tip, chicken bone, iron, walnut shell, and fishbone with a length of < 1 cm, 1-3 cm, and 3-5 cm into 20 pieces of chicken phantom in each size of foreign body (FB). In addition, 1-3 cm long peanut shell, < 1 cm rose spikes, < 1 cm cactus thorns, < 1 cm pellets, and < 1 cm staples were inserted into 20 pieces of chicken for each object. Each of the chicken pieces was placed inside a latex glove and examined by ultrasonography. Results The sensitivity of ultrasonography in the detection of the cactus thorn was 5%, whereas it ranged between 82.5 and 100% for other objects. For glass, plastic, wood, iron, and fishbone, we found that when the size exceeded 1 cm, the sensitivity increased. Conclusions In the evaluation of soft tissue FBs, as the size of the FBs increases, the diagnostic value of ultrasonography increases.
Collapse
|
21
|
Abstract
The clinical manifestations of foreign body (FB) aspiration can range from an asymptomatic presentation to a life-threatening emergency. Patients may present with acute onset cough, chest pain, breathlessness or sub-acutely with unexplained hemoptysis, non-resolving pneumonia and at times, as an incidental finding on imaging. Patients with iatrogenic FB such as an aspirated broken tooth during difficult intubation or a broken instrument are more common scenarios in the intensive care unit (ICU). Patients with post-obstructive pneumonia with or without sepsis, or variable degree of hemoptysis often require ICU level of care and bronchoscopic interventions. Rigid bronchoscopy has traditionally been the modality of choice; however, with the innovation in instrumentation and wider availability of flexible bronchoscopes, most of the FB removal is now successfully performed using flexible bronchoscopy. Proceduralists choose instruments in accordance with their training and expertise. We describe the use of most common instruments including forceps, balloon catheters, and baskets. Role of cryoprobe and LASER in FB removal is reviewed as well. In general, larger working channel bronchoscopes are preferred; however, smaller working channel bronchoscopes may be used in situations when the patients are intubated with a smaller diameter endotracheal or tracheostomy tubes. Large size FB are removed en bloc with the grasping tool, bronchoscope, and endotracheal or tracheostomy tube, requiring preparation to safely re-establish the airway. After FB removal, bronchoscopy is re-performed to identify any residual FB, assess any injury to the airway, suction post-obstructive secretions or pus, control any active bleeding and remove granulation tissue that may be obstructing the airway. Additional interventions like balloon dilatation may be required to dislodge an impacted FB or to maintain patency of bronchial lumen. If bronchoscopic methods fail, surgery may be required for retrieval of FB in symptomatic patients or to resect suppurative or necrotizing lung process. Multidisciplinary approach involving intensivists, surgeons, and anesthesiologists is the key to optimal patient outcomes.
Collapse
Affiliation(s)
- Divyansh Bajaj
- Department of Medicine, Quinnipiac University Frank H. Netter MD School of Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Ashutosh Sachdeva
- Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Desh Deepak
- Department of Respiratory Medicine, Dr. RML Hospital & Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
22
|
Tarasconi A, Perrone G, Davies J, Coimbra R, Moore E, Azzaroli F, Abongwa H, De Simone B, Gallo G, Rossi G, Abu-Zidan F, Agnoletti V, de'Angelis G, de'Angelis N, Ansaloni L, Baiocchi GL, Carcoforo P, Ceresoli M, Chichom-Mefire A, Di Saverio S, Gaiani F, Giuffrida M, Hecker A, Inaba K, Kelly M, Kirkpatrick A, Kluger Y, Leppäniemi A, Litvin A, Ordoñez C, Pattonieri V, Peitzman A, Pikoulis M, Sakakushev B, Sartelli M, Shelat V, Tan E, Testini M, Velmahos G, Wani I, Weber D, Biffl W, Coccolini F, Catena F. Anorectal emergencies: WSES-AAST guidelines. World J Emerg Surg 2021; 16:48. [PMID: 34530908 PMCID: PMC8447593 DOI: 10.1186/s13017-021-00384-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
Collapse
Affiliation(s)
- Antonio Tarasconi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy.
| | - Gennaro Perrone
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA
| | - Ernest Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Francesco Azzaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Hariscine Abongwa
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Belinda De Simone
- Department of Metabolic, Digestive and Emergency Surgery, Centre Hospitalier Intercommunal de Poissy et Saint Germain en Laye, Poissy, France
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Giorgio Rossi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Gianluigi de'Angelis
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Nicola de'Angelis
- Minimally Invasive and Robotic Digestive Surgery Unit, Regional General Hospital F. Miulli, Bari, Ital - Université Paris Est, UPEC, Creteil, France
| | - Luca Ansaloni
- Department of Emergency and general Surgery, Pavia University Hospital, Pavia, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Carcoforo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Alain Chichom-Mefire
- Faculty of Health Sciences, Department of Surgery, University of Buea, Buea, Cameroon
| | - Salomone Di Saverio
- General surgery 1st unit, Department of General Surgery, University of Insubria, Varese, Italy
| | - Federica Gaiani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Mario Giuffrida
- Department of Medicine and Surgery, General Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Andreas Hecker
- Department of General & Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Andrey Litvin
- Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Carlos Ordoñez
- Department of Surgery, Fundacion Valle del Lili - Universidad del Valle, Cali, Colombia
| | | | - Andrew Peitzman
- University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, PA, USA
| | - Manos Pikoulis
- 3rd Department of Surgery, National & Kapodistrian University of Athens, Athens, Greece
| | - Boris Sakakushev
- General Surgery Department, University Hospital St George, Plovdiv, Bulgaria
| | | | - Vishal Shelat
- Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Edward Tan
- Department of Surgery, Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mario Testini
- Academic Unit of General Surgery "V. Bonomo" Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Walter Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy
| |
Collapse
|
23
|
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
| |
Collapse
|
24
|
Carneiro BC, Cruz IAN, Chemin RN, Rizzetto TA, Guimarães JB, Silva FD, Junior CY, Pastore D, Ormond Filho AG, Nico MAC. Multimodality Imaging of Foreign Bodies: New Insights into Old Challenges. Radiographics 2021; 40:1965-1986. [PMID: 33136481 DOI: 10.1148/rg.2020200061] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Traumatic wounds and lacerations are a common reason for patients to present to emergency departments, with retained foreign bodies (FBs) accounting for 7%-15% of cases, particularly those involving the extremities. These retained materials result in a granulomatous tissue response known as an FB reaction, a pathologic attempt to isolate the FB from the host. The most common FB materials are glass, metal, and wood, but other compositions can also be found, such as plastic and animal-derived materials. Clinical history, physical examination, and wound exploration are essential in investigation of retained material but are not sufficient to exclude an FB, and additional investigation is required. Imaging evaluation is a useful tool to help depict and locate an FB, assess possible complications, and guide removal. Conventional radiography, the first-line method in this scenario, is a widely available low-cost depiction method that has good sensitivity for depicting FBs. If the retained material is not depicted at conventional radiography, US can be performed. US is highly sensitive in depicting both radiolucent and radiopaque FBs in superficial locations. For deeper objects, CT may be necessary. MRI is the best imaging modality to delineate local soft-tissue and osseous complications. Retained FBs can result in early and delayed complications, with infection being the most frequent complication. To avoid preventable morbidities related to FBs, radiologists should be familiar with imaging findings and provide essential information to help the attending physician treat each patient. Online supplemental material is available for this article. ©RSNA, 2020.
Collapse
Affiliation(s)
- Bruno C Carneiro
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Isabela A N Cruz
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Renan N Chemin
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Thiago A Rizzetto
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Júlio B Guimarães
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Flávio D Silva
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Ciro Yoshida Junior
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Daniel Pastore
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Alípio G Ormond Filho
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Marcelo A C Nico
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| |
Collapse
|
25
|
Lugo-Fagundo C, Ghodasara N, Fishman EK, Azadi JR. CT evaluation of self-induced and retained foreign bodies in the abdomen and pelvis. Clin Imaging 2021; 80:26-35. [PMID: 34224951 DOI: 10.1016/j.clinimag.2021.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 06/03/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
Computed tomography (CT) can both locate and identify foreign bodies as well as pinpoint complications to help direct treatment. Retained foreign bodies in the abdomen and pelvis can lead to perforation, obstruction, intussusception, fistula formation, and abdominal abscess formation. This article reviews the imaging appearance of incidentally found common foreign bodies and the role of CT in identifying unsuspected foreign bodies.
Collapse
Affiliation(s)
| | - Nevil Ghodasara
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Elliot K Fishman
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Javad R Azadi
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA.
| |
Collapse
|
26
|
Crain MA, Lakhani DA, Kuhnlein R, Balar AB, Neptune S, Parrish D, Shorter N, Adelanwa A, Nguyen TP, Hailemichael E. Small bowel obstruction from hollow foreign body ingestion: A case report and brief review of literature. Radiol Case Rep 2021; 16:1628-1632. [PMID: 33995754 PMCID: PMC8105595 DOI: 10.1016/j.radcr.2021.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 11/22/2022] Open
Abstract
While ingestion of a foreign body by children is common, diagnosis is often challenging, especially when the consumption by a young child is unwitnessed and presenting symptoms mimic other medical conditions. If the foreign body does not pass spontaneously, radiological imaging studies are typically performed, but visualization and identification of the ingested foreign object can be inconclusive, especially when an unidentified mass is radio translucent. Under this circumstance, physicians often have to go on a "fishing expedition", using exploratory endoscopy and/or surgery to identify and extract the object that became lodged. In this report we discuss a case of a 3 year-old boy who presented with abdominal pain and signs of bowel obstruction. Imaging revealed an ingested "radiolucent" foreign body, masqueraded as soft-tissue mass and enteric duplication cyst, delaying the diagnosis. Systematic shape and density reanalysis of CT and US imaging suggested a hollow object lodged at the terminal ileum. The patient underwent exploratory laparotomy with extraction of a hollow toy "fish". There is a dearth of literature regarding hollow ingested objects. This case report highlights the importance of systematic density and shape imaging analyses in order to identify and locate hollow ingested objects.
Collapse
Affiliation(s)
| | - Dhairya A. Lakhani
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Ryan Kuhnlein
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Aneri B Balar
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Susan Neptune
- Department of Surgery, West Virginia University, Morgantown, West Virginia
| | - Dan Parrish
- Department of Surgery, West Virginia University, Morgantown, West Virginia
| | - Nicholas Shorter
- Department of Surgery, West Virginia University, Morgantown, West Virginia
| | - Ayodele Adelanwa
- Department of Pathology, West Virginia University, Morgantown, West Virginia
| | - Thuan-Phuong Nguyen
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Eyassu Hailemichael
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| |
Collapse
|
27
|
Sim S, Wang L, Sun J. A man with chest discomfort. J Am Coll Emerg Physicians Open 2021; 2:e12420. [PMID: 33899046 PMCID: PMC8056121 DOI: 10.1002/emp2.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/13/2021] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shyh‐Shyong Sim
- Department of Emergency MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Liang‐Han Wang
- Department of Emergency MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Jen‐Tang Sun
- Department of Emergency MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan
| |
Collapse
|
28
|
Crawford SB, Lowry D, Watts SH. Evaluation and management of urethral foreign bodies and description of a novel ultrasound-guided catheter-based extraction technique. J Am Coll Emerg Physicians Open 2021; 2:e12398. [PMID: 33728419 PMCID: PMC7934071 DOI: 10.1002/emp2.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/29/2021] [Accepted: 02/11/2021] [Indexed: 11/21/2022] Open
Abstract
There are numerous reports in the medical literature documenting urethral foreign bodies with nearly all cases found in men and often associated with underlying psychiatric disorders, autoerotic stimulation, and/or intoxication. Patients most commonly presented with localized penile pain, hematuria, dysuria, and occasionally obstruction. Although endoscopic removal by a urologist is often the first-line treatment, this report describes evaluation and management considerations and presents a novel extraction technique that may allow emergency physicians in consultation with urology to perform removal of some unusual urethral foreign bodies in the emergency department. We report a novel extraction technique using a pediatric foley catheter under ultrasound guidance that has been applied during multiple encounters with 2 individuals who have each presented multiple times at a single emergency department (ED) for evaluation because of urethral foreign body insertion. The foreign body materials have ranged from small pieces of rubber to cellophane to styrofoam and most commonly plastic utensils. Urologic extraction may be required in some cases, but ED removal can be considered. A final discussion of the creation of a multidisciplinary care plan to address resource use concerns also is described.
Collapse
Affiliation(s)
- Scott B. Crawford
- Department of Emergency MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Drew Lowry
- Department of Emergency MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Susan H. Watts
- Department of Emergency MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| |
Collapse
|
29
|
Unexpected Fatal Tension Pneumothorax: A Case Report Regarding a Patient With Multiple Traumas on Air Medical Transportation. Air Med J 2021; 40:127-129. [PMID: 33637277 DOI: 10.1016/j.amj.2020.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 12/26/2022]
Abstract
A 45-year-old male driver was assessed by the road rescue team after a car crash. He was in shock and had a deep second-degree burn, multiple bone fractures, and chest wounds. After stabilization, he was delivered to the nearest local clinic by an ambulance. The doctor decided to refer him via air transportation due to the lack of sufficient facilities and the urgent need for an intensive care unit after coordination with the nearest hospital and air medical team. A Bell 214C medical helicopter was called, and transfer was initiated after patient preparation by the air medical team. A few minutes later, his clinical condition deteriorated, and because of the suspicion of a tension pneumothorax, needle thoracostomy was performed. Crosswind and frequent helicopter movements interfered with tube thoracostomy, leading the air medical crew's decision to land. After completion of tube thoracostomy and during endotracheal intubation, his heart rhythm converted to bradycardia and then asystole. Unfortunately, despite 30 minutes of cardiopulmonary resuscitation, the patient died. The forensic report stated that a glassy foreign body led to penetrating chest wall injury and left lung perforation, possibly causing the tension pneumothorax, cardiopulmonary arrest, and death.
Collapse
|
30
|
Yocum AD, Dennison JL, Simon EL. Esophageal Obstruction and Death in a Nonverbal Patient. J Emerg Med 2021; 60:e109-e113. [PMID: 33583613 DOI: 10.1016/j.jemermed.2020.12.033] [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: 10/28/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND There are more than 100,000 cases of esophageal foreign body in the United States each year. Most cases resolve spontaneously; however, complete esophageal obstruction is a medical emergency. Patients with developmental disabilities are at high risk, because a large percentage of this population is effected by dysphagia, pica, tooth loss, or impulsive swallowing. In some cases, the diagnosis of esophageal foreign body can be made clinically, with the typical presentation including coughing, inability to tolerate secretions, drooling, vomiting, and dysphagia. In other instances, imaging is needed to confirm the diagnosis. CASE REPORT A nonverbal adult patient with history of mental retardation and dysphagia presented to the emergency department (ED) after a choking episode with persistent coughing. An x-ray study of the chest showed mild opacity at the left lung base and she was discharged with antibiotics. She returned to the ED that day with worsening symptoms suggestive of aspiration pneumonia. A computed tomography scan of the chest revealed numerous cylindrical objects in the esophagus, later identified as crayons. At least 28 crayons were removed via 3 endoscopies. During this time, the patient developed aspiration pneumonia, respiratory distress, and septic shock. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Delayed recognition of foreign body puts patients at risk for esophageal perforation, aspiration, airway compromise, infection, sepsis, and death. In nonverbal patients presenting with upper respiratory symptoms, it is especially important to consider esophageal foreign body in the differential diagnosis, because this group is high risk for missed diagnosis and complications secondary to the foreign body.
Collapse
Affiliation(s)
- Andrew D Yocum
- Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio
| | - Jennifer L Dennison
- Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, Ohio; Lake Erie College of Osteopathic Medicine at Seton Hill, Greensburg, Pennsylvania
| | - Erin L Simon
- Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio
| |
Collapse
|
31
|
Food bolus and oesophageal foreign body: a summary of the evidence and proposed management process. Eur Arch Otorhinolaryngol 2021; 278:3613-3623. [PMID: 33417148 DOI: 10.1007/s00405-020-06569-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/11/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Food bolus and oesophageal foreign bodies are a common presentation that may be managed by otolaryngologists, gastroenterologists, acute medicine physicians and accident and emergency. The condition is highly variable with presentations ranging from well patients whose obstruction spontaneously passes to peri-arrest with severe aspiration or impending airway compromise. Management of this condition is heterogeneous and often depends on the specialty the patient is originally admitted under. There exist European and American guidelines from the perspective of gastroenterology, but there are no UK-based guidelines and limited consideration of the role of the otolaryngologists and rigid oesophagoscopy. METHODS An extensive literature search was carried out to generate conclusions on key management questions for food bolus and oesophageal foreign bodies. This was then summarised into both a written summary of the evidence and a graphical decision tree. RESULTS This paper is a review article and presents conclusions regarding management options for food bolus and oesophageal foreign bodies. CONCLUSION This article considers the current evidence surrounding investigation and management of oesophageal food bolus and foreign body. It draws conclusions regarding presentation, investigation and subsequent operative treatment. As part of this process, we propose a graphical decision tree to assist in management decisions.
Collapse
|
32
|
Ha JH, Jeong BH. Airway Foreign Body Mimicking an Endobronchial Tumor Presenting with Pneumothorax in an Adult: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:50. [PMID: 33430107 PMCID: PMC7827418 DOI: 10.3390/medicina57010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Abstract
Foreign body (FB) aspiration occurs less frequently in adults than in children. Among the complications related to FB aspiration, pneumothorax is rarely reported in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by using radiographs and bronchoscopy, some patients are misdiagnosed with endobronchial tumors. We describe a case of airway FB that mimicked an endobronchial tumor presenting with pneumothorax in an adult. A 77-year-old man was referred to our hospital due to pneumothorax and atelectasis of the right upper lobe caused by an endobronchial nodule. A chest tube was immediately inserted to decompress the pneumothorax. Chest computed tomography with contrast revealed an endobronchial nodule that was seen as contrast-enhanced. Flexible bronchoscopy was performed to biopsy the nodule. The bronchoscopy showed a yellow spherical nodule in the right upper lobar bronchus. Rat tooth forceps were used, because the lesion was too slippery to grasp with ellipsoid cup biopsy forceps. The whole nodule was extracted and was confirmed to be a FB, which was determined to be a green pea vegetable. After the procedure, the chest tube was removed, and the patient was discharged without any complications. This case highlights the importance of suspecting a FB as a cause of pneumothorax and presents the possibility of misdiagnosing an aspirated FB as an endobronchial tumor and selecting the appropriate instrument for removing an endobronchial FB.
Collapse
Affiliation(s)
- Jun-Ho Ha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| |
Collapse
|
33
|
Sun Y, Ge YL, Li LQ, Liu Y, Lu Y, Jing Q, Chen Y, Li WQ, Hou LL, Min P. Elevated carcinoembryonic antigen and bronchial obstruction caused by a rotten vegetable leaf mimic lung cancer: A case report. J Clin Lab Anal 2021; 35:e23579. [PMID: 32964536 PMCID: PMC7843268 DOI: 10.1002/jcla.23579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tracheobronchial foreign body aspiration is a potentially risky medical event, while the condition often requires early detection and rapid intervention to improve respiratory symptoms and prevent major morbidity. Notably, foreign bodies may not be identified and they are likely to be mistaken for neoplastic lesions. However, CEA, as one of tumor markers, presents to be available for assisting in lung cancer diagnosis, especially for non-small-cell lung cancer, while the specificity of CEA is not high. METHODS Here, we described a case of bronchial opening obstruction with elevated carcinoembryonic antigen (CEA) that was firstly misdiagnosed as lung cancer and proved as foreign body aspiration in the upper lobe bronchus of right lung by bronchoscopy. RESULTS Carcinoembryonic antigen level increased. CT scan demonstrated a cavitation accompanied by multiple small nodular shadows appeared in the right upper lobe field. Bronchoscopy suggested right upper lobe bronchus was blocked by a brown smooth organism with plenty of purulent materials, which was proved as a rotten vegetable leaf. CONCLUSIONS Elevated CEA and bronchial obstruction are not typical manifestations of lung cancer. Bronchoscopy is crucial for making a reliable diagnosis.
Collapse
Affiliation(s)
- Ye Sun
- Department of Respiratory MedicineNorth China University of Science and Technology Affiliated HospitalTangshanChina
| | - Yan L. Ge
- Department of Respiratory MedicineNorth China University of Science and Technology Affiliated HospitalTangshanChina
| | - Li Q. Li
- Department of Respiratory MedicineNorth China University of Science and Technology Affiliated HospitalTangshanChina
| | - Yang Liu
- Department of Respiratory MedicineNorth China University of Science and Technology Affiliated HospitalTangshanChina
| | - Yang Lu
- Department of Respiratory MedicineNorth China University of Science and Technology Affiliated HospitalTangshanChina
| | - Qin Jing
- Department of Respiratory MedicineNorth China University of Science and Technology Affiliated HospitalTangshanChina
| | - Yi Chen
- Department of Respiratory MedicineNorth China University of Science and Technology Affiliated HospitalTangshanChina
| | - Wen Q. Li
- Department of Respiratory MedicineNorth China University of Science and Technology Affiliated HospitalTangshanChina
| | - Lin L. Hou
- Department of Respiratory MedicineNorth China University of Science and Technology Affiliated HospitalTangshanChina
| | - Pei Min
- Department of Respiratory MedicineNorth China University of Science and Technology Affiliated HospitalTangshanChina
| |
Collapse
|
34
|
Wong E, Steen C, Lim CSH, Keong B. Hand and foot in mouth syndrome? A disturbing computed tomography finding. ANZ J Surg 2020; 91:1032-1034. [PMID: 32956505 DOI: 10.1111/ans.16323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/05/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Enoch Wong
- Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia.,Department of Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Christopher Steen
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia
| | | | - Ben Keong
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia
| |
Collapse
|
35
|
Coelho MP, Goel A, Klumpp M, Mincolla M. Intraluminal hyperdense appearance of the small bowel on high resolution computed tomography of the abdomen and pelvis secondary to use of Calcium Carbonate tablets (Tums) mimicking a small bowel fistula. Radiol Case Rep 2020; 15:1875-1878. [PMID: 32884604 PMCID: PMC7453116 DOI: 10.1016/j.radcr.2020.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022] Open
Abstract
Hyperdensity within the small bowel is most commonly seen with positive oral contrast agents, intraluminal hemorrhage and less likely an abnormal fistulous connection with the colon containing rectally administered contrast. We present the case of a 57-year-old female with a complex history of breast cancer and multiple abdominal surgeries presenting with intraluminal hyperdense small bowel on computed tomography (CT) performed with rectal contrast. Postsurgical CT with rectal contrast, and no oral contrast, showed multifocal regions of intraluminal hyperdensity with the small bowel anterior to and close to the surgical anastomosis. This raised concerns for a fistula between the colon and small bowel; however, surgical exploration demonstrated an intact anastomosis without a coloenteric fistula. Additional history notes that the patient consumed an increased dose of calcium carbonate tablets for a few days prior to obtaining the scan and this intraluminal hyperdense appearance of the small bowel was then attributed to this. We conclude that ingested over the counter medications can pose an imaging dilemma for radiologists as their appearance on CT could falsely mimic pathology. It is imperative to obtain a thorough clinical history in such cases to provide accurate diagnoses and decrease unwanted imaging and clinical intervention. It is also important for radiologists to be aware of the appearances of commonly consumed over the counter medications that can mimic pathology as demonstrated by this case.
Collapse
Affiliation(s)
- Marlon P Coelho
- SUNY Upstate Medical University, Department of Radiology, 750 E. Adams Street, Syracuse, NY 13210, USA
| | - Atin Goel
- SUNY Upstate Medical University, Department of Radiology, 750 E. Adams Street, Syracuse, NY 13210, USA
| | - Matthew Klumpp
- SUNY Upstate Medical University, Department of Radiology, 750 E. Adams Street, Syracuse, NY 13210, USA
| | - Marissa Mincolla
- SUNY Upstate Medical University, Department of Radiology, 750 E. Adams Street, Syracuse, NY 13210, USA
| |
Collapse
|
36
|
Baumeister R, Thali MJ. Unusual foreign bodies visualized by postmortem computed tomography in a deceased with borderline personality disorder. Radiol Case Rep 2020; 15:1618-1622. [PMID: 32685082 PMCID: PMC7358626 DOI: 10.1016/j.radcr.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/08/2023] Open
Abstract
The objective of this case report is the visualization and assessment of ingested or inserted foreign bodies by postmortem computed tomography and autopsy. The presence of foreign objects in the gastrointestinal tract involves, among many other medical subdisciplines, the fields of forensic medicine and psychiatry. We present a case of an 18-year-old female Caucasian with borderline personality disorder who was found unconscious in a closed psychiatric ward with suspected ingested foreign bodies. Cardiopulmonary resuscitation was unsuccessful. Postmortem computed tomography revealed several sharp foreign bodies in the intestine varying in radiodensity and shape but not perforating any anatomic structures. The autopsy showed well-preserved tablets in the intestine, a few inserted glass fragments and one metal fragment. Ultimately, fatal intoxication involving a mixture of opioids, benzodiazepines, neuroleptics and antidepressants resulted. This case illustrates the potential contribution of postmortem computed tomography in diagnosing, localizing and defining ingested and inserted foreign bodies in deceased as well as living individuals. Thus, diagnostic imaging might increase safety not only for the affected individuals but also for medical staff.
Collapse
Affiliation(s)
- Rilana Baumeister
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich CH-8057, Switzerland
| | - Michael Josef Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, Zurich CH-8057, Switzerland
| |
Collapse
|
37
|
Chang HC, Lee YH, Yang MC. A melting, encapsulated, calcified pulmonary nodule in a healthy 51-year-old woman: a case report. BMC Med Imaging 2020; 20:44. [PMID: 32357852 PMCID: PMC7195784 DOI: 10.1186/s12880-020-00448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Foreign body aspiration is less common in healthy adults, which makes diagnosis difficult. Early detection of smaller/sharp foreign bodies in the distal airway is more difficult because patients might have no symptoms and imaging studies could appear normal. Here we describe the course of a small, sharp foreign body (chicken bone) lodged in the distal airway of a healthy middle-aged woman. The chicken bone was initially thought to be an old calcified tuberculoma. However, it was encased in a dilated bronchus without obvious surrounding lymphadenitis or parenchymal infiltration, and it melted with time. Two years later, histopathological examination revealed that the calcified lesion was an aspirated chicken bone with a concomitant tuberculoma. Case presentation A 51-year-old woman showed an old calcified tuberculoma in the upper right lung lobe during routine examinations. It was “encased” in a dilated bronchus, although it was not raised from the surrounding lung parenchyma. The size of the calcified part decreased (“melted”) with time, and the surrounding inflammation progressed 2 years later, a phenomenon never described in association with tuberculosis. Bronchoscopy revealed a fragment of chicken bone lodged in the next two branches of the upper right posterior bronchus. Surgical segmentectomy was performed, and histopathological examination revealed that the calcified lesion was formed by a fragment of chicken bone as well as a tuberculoma. Eventually, the patient recalled an episode of choking on a chicken bone 5 years ago; she believed that she had coughed it out completely at that time. Conclusions The “melting” and “encased” phenomena observed in the present case could be useful imaging findings for early detection of small foreign body aspiration in the distal airway.
Collapse
Affiliation(s)
- Hsu-Chao Chang
- Department of Radiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Yi-Hsin Lee
- Department of Anatomy Pathology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Mei-Chen Yang
- School of Medicine, Tzu Chi University, Hualien, Taiwan. .,Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.
| |
Collapse
|
38
|
Magnetic Apposition across the Epiglottis: Radiographic and Operative Correlation of a Rare Hypopharyngeal Foreign Body. Case Rep Radiol 2020; 2020:3245634. [PMID: 32089938 PMCID: PMC7021466 DOI: 10.1155/2020/3245634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background and Aim. Rare-earth magnet ingestions are a subset of foreign body ingestions and can result in significant morbidity secondary to pressure necrosis. These magnets are best visualized radiographically, typically located in the gastrointestinal tract. However, unusual locations of magnetic adherence may include the hypopharynx along the epiglottis, where only 2 previous cases have been reported. Clinicians should be aware of the potential dangers of rare-earth magnet ingestion and consider atypical locations of attachment in the appropriate clinical setting. Case Presentation. We present an interesting case of a fourteen-year-old female patient who presents with witnessed ingestion of multiple rare-earth magnets. Soft-tissue neck radiographs demonstrate two adjacent rounded radiopaque densities in the hypopharynx. Intraoperative images confirmed the radiographic findings and identified two magnetic balls stuck along the dorsal and ventral aspect of the epiglottis without evidence of pressure necrosis.
Collapse
|
39
|
Feng S, Peng H, Xie H, Bai Y, Yin J. Management of Sharp-Pointed Esophageal Foreign-Body Impaction With Rigid Endoscopy: A Retrospective Study of 130 Adult Patients. EAR, NOSE & THROAT JOURNAL 2020; 99:251-258. [PMID: 31996037 DOI: 10.1177/0145561319901033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To propose a management algorithm for adult patients with sharp-pointed esophageal foreign-body impaction (EFBI) who have rigid endoscopy (RE) indications and to conduct a retrospective analysis of their data. METHODS All adult patients who received RE at the Department of Otorhinolaryngology in Beijing Shijitan Hospital between January 2017 and May 2019 were enrolled. The demographics, clinical characteristics, and management data were collected and analyzed. RESULTS A total of 130 patients were identified, 56.9% were female with median age 60 years. More than half (56.9%) of patients had foreign-body (FB) ingestion on holidays. The most frequent FBs were jujube pits (66.9%) and bones (23.8%). There is a significant female predominance in ingestion of jujube pits (65.5%, P = .005). The most common symptoms were odynophagia (49.2%) and sore throat (47.7%). The majority (96.8%) of FB founded were lodged at upper esophagus. In all, 74 patients were categorized as having mild complications and 54 having significant complications. Time interval from ingestion to presentation longer than 15 hours was an independent risk factor for significant complications, while esophagogram with barium as a protective factor. CONCLUSIONS Long-time interval from ingestion to presentation will lead to high risk of significant complications. Computed tomography should be a prioritized imaging method for all patients suspected with EFBI, and multidisciplinary collaboration is recommended. Besides, mass education on eating habits is necessary.
Collapse
Affiliation(s)
- Shui Feng
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hong Peng
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hong Xie
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yunbo Bai
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Jinshu Yin
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| |
Collapse
|
40
|
Azar A, Wessell DE, Janus JR, Simon LV. Fractured aluminum nasopharyngeal swab during drive-through testing for COVID-19: radiographic detection of a retained foreign body. Skeletal Radiol 2020; 49:1873-1877. [PMID: 32827082 PMCID: PMC7441843 DOI: 10.1007/s00256-020-03582-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 02/02/2023]
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic has increased the need for safe and efficient testing as a key containment strategy. Drive-through testing with nasopharyngeal swab has been implemented in many places in the USA as it allows for expeditious testing of large numbers of patients, limits healthcare workers' risk of exposure, and minimizes the use of personal protective equipment. We present a case where the aluminum shaft of the nasopharyngeal swab fractured during specimen collection at a drive-through testing facility and was suspected to have remained in the asymptomatic patient. Initial evaluation with a series of radiographs covering the skull base, neck, chest, and abdomen did not reveal the swab. On further clinical evaluation, the swab was found endoscopically, lodged between the left inferior turbinate and nasal floor, and was removed by an otorhinolaryngologist. Using a phantom model, we aimed to delineate an imaging technique to better visualize the aluminum shaft of the nasopharyngeal swab on radiographs to help in identification. A technique using lower tube voltage (kVp) with tight collimation centered at the nasal bones area produced the best visualization of the aluminum shaft of the swab. Recognition that aluminum foreign bodies may be difficult to visualize radiographically and optimization of radiograph acquisition technique may help guide clinical management in unusual cases. Further evaluation with computed tomography or endoscopy should be considered in suspected cases where radiographs are negative.
Collapse
Affiliation(s)
- Antoine Azar
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224 USA
| | - Daniel E. Wessell
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224 USA
| | - Jeffrey R. Janus
- Department of Otorhinolaryngology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224 USA
| | - Leslie V. Simon
- Department of Emergency Medicine, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224 USA
| |
Collapse
|
41
|
Kelly GS, Stolbach AI. Esophageal Foreign Body Leading to Perforation. J Emerg Med 2019; 57:728-729. [PMID: 31607524 DOI: 10.1016/j.jemermed.2019.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/14/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Geoffrey Stuart Kelly
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew Ian Stolbach
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Lebin JA, Wu EH, McCoy AM, Gross JA. Young Man After Overdose. J Emerg Med 2018; 55:e109-e110. [PMID: 30120014 DOI: 10.1016/j.jemermed.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/19/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Jacob A Lebin
- Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - En-Haw Wu
- Department of Radiology, University of Washington, Seattle, Washington
| | - Andrew M McCoy
- Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Joel A Gross
- Department of Radiology, University of Washington, Seattle, Washington
| |
Collapse
|
44
|
Govind G, Siriwardana HPP, Sdralis E, Ram M, Lee P, Charalabopoulos A. Chronic ileitis with transmural migration of ingested foreign body treated by laparoscopy. Acta Chir Belg 2018; 118:315-319. [PMID: 28920530 DOI: 10.1080/00015458.2017.1376432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Ingestion of foreign bodies such as fish bone or chicken bone is relatively common in adults; however, resultant transmural migration is extremely rare. METHODS We present a case of a 79-year-old woman with chronic low-grade abdominal pain, worsening over the last 4 days. Computed tomography revealed segmental small bowel wall thickening with chronic inflammation suggestive of Crohn's ileitis and oral steroids were commenced; only later, ingestion of a foreign body was suspected. RESULTS AND CONCLUSION At diagnostic laparoscopy, a linear foreign body resembling a wooden splinter was identified. It had partly migrated through the chronically inflamed bowel wall without causing perforation or abdominal contamination. It was removed laparoscopically without an enterotomy or bowel resection. Microscopy revealed non-viable bone, likely fish or chicken bone. The patient made an uneventful recovery and was discharged 3 days later. Herein we emphasise on the differential diagnosis and presentation of chronically ingested foreign bodies, as well as the feature of chronic ileitis with uncomplicated transmural migration of the ingested foreign body that was treated laparoscopically without an enterotomy.
Collapse
Affiliation(s)
- Garima Govind
- Department of General and Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, UK
| | - H. P. Priyantha Siriwardana
- Department of General and Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, UK
| | - Elias Sdralis
- Department of General and Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, UK
| | - Manisha Ram
- Department of General and Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, UK
| | - Peng Lee
- Department of General and Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, UK
| | - Alexandros Charalabopoulos
- Department of General and Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, UK
| |
Collapse
|
45
|
Novel Uses of Point-of-Care Ultrasound for Pediatric Foreign Bodies: An Emergency Department Case Series. J Emerg Med 2018; 55:530-533. [DOI: 10.1016/j.jemermed.2018.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/15/2018] [Accepted: 06/05/2018] [Indexed: 01/06/2023]
|
46
|
Piotto L, Gent R. The value of ultrasound in the investigation of ingested foreign bodies in children. SONOGRAPHY 2018. [DOI: 10.1002/sono.12139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Lino Piotto
- Division of Medical Imaging; Women's and Children's Hospital; South Australia Australia
| | - Roger Gent
- Division of Medical Imaging; Women's and Children's Hospital; South Australia Australia
| |
Collapse
|
47
|
Jaggi S, Kumar A, Garg K, Aggarwal D, Kundu R. Foreign Body Aspiration: An Unusual Presentation and Outcome. J Clin Diagn Res 2017; 11:OD08-OD09. [PMID: 29207761 DOI: 10.7860/jcdr/2017/32020.10643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/25/2017] [Indexed: 12/28/2022]
Abstract
Foreign body aspiration mostly presents as acute emergency with cough, choking and dyspnoea. Rarely aspiration of foreign body may be the underlying cause in patients presenting with long term symptomatologies. Here is a case of 60-year-old male who came for surgical management of cholelithiasis. During his workup, X-ray chest revealed right paracardiac opacity. Fibre-optic bronchoscopy showed a mass lesion in right main bronchus. It was taken out of the airways by flexible bronchoscope but could not be retrieved. Subsequent chest radiographs showed marked improvement.
Collapse
Affiliation(s)
- Surabhi Jaggi
- Junior Resident, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32 A, Chandigarh, Union Territory, India
| | - Anuj Kumar
- Junior Resident, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32 A, Chandigarh, Union Territory, India
| | - Kranti Garg
- Assistant Professor, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32 A, Chandigarh, Union Territory, India
| | - Deepak Aggarwal
- Associate Professor, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32 A, Chandigarh, Union Territory, India
| | - Reetu Kundu
- Assistant Professor, Department of Pathology, Government Medical College and Hospital, Sector 32 A, Chandigarh, Union Territory, India
| |
Collapse
|
48
|
Re: Palmer et al.: Urethral Foreign Bodies: Clinical Presentation and Management (Urology 2016;97:257-260). Urology 2017; 100:256-258. [DOI: 10.1016/j.urology.2016.07.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 12/26/2022]
|
49
|
Virgilio E, Giuliani D, Nigro A, Gasparrini M, Balducci G. Cervical Esophagotomy for Removal of an Ingested Clam Shell: A Very Uncommon Foreign Body Ingestion. Med Princ Pract 2017; 26:390-392. [PMID: 28490026 PMCID: PMC5768122 DOI: 10.1159/000477403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 05/10/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report the removal of an ingested clam shell that was firmly impacted in the esophagus. CLINICAL PRESENTATION AND INTERVENTION A 77-year-old man presented at our hospital with acute dysphagia after eating a seafood risotto. An urgent dedicated examination (noncontrast helical multislice computed tomography scan of the neck and flexible esophagoscopy) detected a clam shell lodged in the upper esophagus. After several unsuccessful endoscopic attempts, a lifesaving cervical esophagotomy was performed and the foreign body was retrieved. CONCLUSION This patient who ingested clam shell recovered well following the retrieval of the foreign body by performing a lifesaving cervical esophagotomy.
Collapse
Affiliation(s)
- Edoardo Virgilio
- *Edoardo Virgilio, MD, PhD, St. Andrea Hospital, via di Grottarossa 1035-39, IT-00189 Rome (Italy), E-Mail
| | | | | | | | | |
Collapse
|