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Shufen X, Juan Z, Ling W, Fangru D. Delayed pathological finding of a small fish bone causing a purulent cyst in the pharynx: a case report. J Int Med Res 2023; 51:3000605231187947. [PMID: 37522303 PMCID: PMC10392475 DOI: 10.1177/03000605231187947] [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: 08/01/2023] Open
Abstract
We describe the case of a patient who swallowed a small fish bone and felt it lodge in her pharynx, but failed to seek medical attention in a timely manner. One week later, no foreign body was found in the hypopharynx or larynx, but a small purulent cyst was present in the epiglottic vallecula. A computed tomography scan showed a high-density area on the lingual surface of the epiglottis, which was considered to represent an embedded fish bone. A week later, the patient's discomfort had subsided, and flexible videoendoscopy showed that the purulent cyst in the epiglottic vallecula had disappeared. We surmise that the purulent cyst had ruptured spontaneously and the foreign body had been discharged. This represents an example of how an impacted small foreign body may be spontaneously discharged from the body.
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Affiliation(s)
- Xiao Shufen
- Department of Otorhinolaryngology-Head and Neck Surgery, Bethune International Peace Hospital, The 980th Hospital of the Joint Logistics Support Force, Shijiazhuang, China
| | - Zhang Juan
- Department of Pharmacy, The Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
| | - Wang Ling
- Department of Otorhinolaryngology-Head and Neck Surgery, Bethune International Peace Hospital, The 980th Hospital of the Joint Logistics Support Force, Shijiazhuang, China
| | - Dong Fangru
- Department of Otorhinolaryngology-Head and Neck Surgery, Bethune International Peace Hospital, The 980th Hospital of the Joint Logistics Support Force, Shijiazhuang, China
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2
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Buchanan ME, Fishman EK, Azadi JR. CT Evaluation of the Esophagus: The Role of CT Imaging and CT Imaging Findings in Diagnosing Esophageal Abnormalities. Curr Probl Diagn Radiol 2023; 52:289-299. [PMID: 37045693 DOI: 10.1067/j.cpradiol.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/16/2023] [Indexed: 04/14/2023]
Abstract
Esophageal disorders are commonly encountered by radiologists on computed tomography. Characteristic computed tomography findings of various esophageal pathologies have been extensively described and are important for the radiologist to know to facilitate accurate and timely diagnosis. Esophageal disorders can be broadly classified as infectious and inflammatory, congenital/structural, or neoplastic. This paper reviews the most common presentations of various esophageal pathologies within each classification.
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Affiliation(s)
- Mary E Buchanan
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Javad R Azadi
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD.
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3
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Dewhurst S, Kyang LS, Jardeleza C, Pham T. Fishing for a fish bone: migratory foreign body in a regional hospital. ANZ J Surg 2023; 93:762-763. [PMID: 36001746 DOI: 10.1111/ans.18003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Suzannah Dewhurst
- Department of Surgery, Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lee S Kyang
- Department of Surgery, Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Camille Jardeleza
- Department of Surgery, Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
| | - Tuan Pham
- Otolaryngology Head and Neck Surgery Unit, The Canberra Hospital, Garran, Australian Capital Territory, Australia
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Johnson GR, Ullah I, Abell R. Role of Nose to Pelvis Imaging in the Evaluation of Foreign Body Ingestion: A Case of Magnet Ingestion in a 2-Year-Old. JPGN REPORTS 2022; 3:e221. [PMID: 37168631 PMCID: PMC10158319 DOI: 10.1097/pg9.0000000000000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/02/2022] [Indexed: 05/13/2023]
Abstract
Foreign body ingestion (FBI) of small-rare-earth-magnets (SREM) sets are associated with high morbidity and mortality, as these tend to cause significant mucosal injury. Current clinical guidelines for the evaluation of FBI do not include imaging of the nose and neck. A 2-year-old patient presented with known SREM ingestion, with location confirmed in the right lower quadrant on imaging at the time of initial evaluation. Subsequent imaging involving the neck revealed additional magnets lodged in the patient's hypopharynx, which were missed on initial evaluation. This case highlights the importance of considering advanced imaging of the nose and neck to uncover extraintestinal foreign bodies.
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Affiliation(s)
- Guylda R. Johnson
- From the Department of Internal Medicine & Pediatrics, University of Rochester Medical Center
| | - Imdad Ullah
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Rochester Medical Center
| | - Rebecca Abell
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Rochester Medical Center
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Zanchetta M, Monti E, Latham L, Costa J, Marzorati A, Odeh M, Colombo EM, Ietto G, Inversini D, Iovino D, Maffioli MP, Festi LF, Carcano G. Dental Prosthesis in Esophagus: A Right Cervicotomic Approach. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081170. [PMID: 36013349 PMCID: PMC9409762 DOI: 10.3390/life12081170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
Foreign body ingestion in the upper digestive tract is a relatively common emergency. Less than 1% have to be treated surgically. We report the case of a 68-year-old man who ingested a dental prosthesis, probably during a seizure, and thus unknowingly, and presented two days later to the emergency department complaining of a mild dysphagia. A chest radiograph showed the presence of a removable dental prosthesis in the upper esophageal tract. The patient was brought to the operating room where a multidisciplinary equipe was assembled. Two attempts of retrieval with a flexible and a rigid endoscope failed because the removable dental prosthesis was stuck in the right pyriform sinus. Therefore, the surgeon performed an uncommon right cervicotomy and retrieved the foreign body through a right-side esophagotomy. The surgical approach depends on the nature and location of the foreign body. Urgent treatment is required whenever the patient develops dyspnea or dysphagia because of the high risk of inhalation and asphyxia. Removal of any esophageal foreign body has to be performed within 12-24 h. Repeated attempts to retrieve large dental prosthesis using an endoscope may result in esophageal perforation therefore when such risk of complication is too high, a surgical approach becomes inevitable. In our opinion, surgery remains the extrema ratio after a failed endoscopic retrieval attempt but can be lifesaving despite high risk of complications.
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Affiliation(s)
- Matteo Zanchetta
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Correspondence:
| | - Elisa Monti
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
| | - Lorenzo Latham
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Jessica Costa
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
| | - Alessandro Marzorati
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Murad Odeh
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Elisabetta Marta Colombo
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Giuseppe Ietto
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Davide Inversini
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Domenico Iovino
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Marco Paolo Maffioli
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Otorinolaringoiatria, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy
| | - Luigi Fiorenzo Festi
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Giulio Carcano
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
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Giordano D, Botti C, Iotti V, Ghidini A. Foreign Body in the Cervical Oesophagus: A Case Report. Curr Med Imaging 2022; 18:1117-1119. [PMID: 35379156 DOI: 10.2174/1573405618666220404110751] [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: 09/29/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Foreign bodies in the upper aerodigestive tract represent an uncommon cause of visits to emergency departments. In the majority of cases, foreign bodies do not go beyond the pharynx. They cause dyspnoea or pneumonia if they reach the tracheo-bronchial tree. If ingested, they will pass spontaneously through the gastrointestinal canal in the majority of cases. Nevertheless, especially in case of sharp-pointed or large objects, the foreign bodies can stop in the oesophagus. In case of dysphagia, stinging sensation and/or odynophagia occurring after eating a meal, a foreign body in the upper aerodigestive tract should be suspected. If not clinically visible, imaging is required. CASE PRESENTATION A 72-year-old woman presented to the Emergency Department with pharyngodynia, odynophagia, stinging, dysphagia, and sialorrhea for 12 hours. Her symptoms started after eating a meal with meat. The patient underwent a standard two-projection radiogram of the neck. The antero-posterior projection radiogram was unremarkable. The lateral projection radiogram showed 16 millimetres in maximum length radiopaque foreign body within the cervical oesophagus. The patient underwent transoral flexible oesophagoscopy under general anaesthesia, with successful removal of the foreign body (bony fragment). Her symptoms improved rapidly after the procedure, and the patient was discharged after 48 hours in good health. CONCLUSION A foreign body in the cervical oesophagus may lead to visceral perforation. Once suspected, every effort should be made to identify and remove the foreign body to avoid potentially catastrophic consequences. In some cases, imaging could be necessary to detect the foreign body.
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Affiliation(s)
- Davide Giordano
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Iotti
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Chen H, Wu C, Zhang Z, Liu J, Xia Z, Zhang S, Ye F. Migratory pharyngeal foreign bodies and related complications: Analysis of 20 cases. Am J Otolaryngol 2022; 43:103390. [PMID: 35151174 DOI: 10.1016/j.amjoto.2022.103390] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/30/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the diagnostic approach and therapeutic method of migratory pharyngeal foreign bodies and related complications, to improve the understanding of such disease and to reduce misdiagnosis and missed diagnosis. MATERIAL AND METHODS A retrospective study was performed by collecting patients who were treated because of the related complications caused by migratory pharyngeal foreign bodies from 2012 to 2020. RESULTS A total of 20 patients were admitted to hospital due to the related complications. 14 cases showed cervical mass; 3 cases showed abscess of the mouth floor; 1 cases showed retropharyngeal abscess; 1 cases showed laryngeal granuloma; 1 cases showed mass of tongue. All patients received imaging examination of B-ultrasonography or computed tomography (CT). 19 patients were treated by surgery, and 1 patient was taken conservative treatment. All foreign bodies was successfully removed. As for the type of foreign bodies, there have 15 cases of fishbone, 2 cases of crabshell, 2 cases of shrimp shell, 1 cases of duck bone. CONCLUSIONS Migrating foreign bodies and related complications are rare in clinic, much attention should be paid to avoid missed diagnosis or misdiagnosis.
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Feinmesser G, Eyal A, Shrot S, Belenky EA, Mansour J, Livneh N, Knoller H, Schindel H, Alon EE. Comparison of lateral neck X-ray to neck CT in patients with suspicious bone impaction: "Old habits die hard". Am J Otolaryngol 2022; 43:103237. [PMID: 34560599 DOI: 10.1016/j.amjoto.2021.103237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bone impaction (BI) is a common cause for emergency room visits. Among foreign bodies, fish bone is considered the most common. The sensitivity of symptoms in predicting BI is relatively low, making imaging a central tool to aid diagnosis. Current imaging practices include both neck plain film radiography and none-contrast CT scans of the neck. We evaluated the accuracy of neck plain film radiography and CT scans of the neck for the diagnosis of BI. METHODS Retrospective review of all patients who presented to the emergency room between 2009 and 2016 with a suspicious history of BI whom underwent plain film neck radiography or CT. All Images were reviewed by two neuro-radiologist blinded to the clinical symptoms and findings. Symptoms, clinical findings and images results were compared to the final diagnosis. RESULTS 89 patients (30.7%), out of 290 patients who presented with complaints of BI, were diagnosed with BI. Mean age was 44.7 years old. Plain film neck radiography failed to predict BI (sen. 14.4%, spe 89.8% accuracy 63.2%), neck CT has an improved accuracy and sensitivity in locating BI (sen. 83.3%, spe. 94.1% accuracy 92.5%). Interobserver agreement between the two neuro-radiologists was moderate (0.46) and substantial (0.77) in neck radiography and CT images, respectively. Neck radiography missed 60 (out of 61) oropharyngeal BI's. CONCLUSION Neck radiography has high inter-observer variability and low sensitivity for the diagnosis of BI. Neck CT should be the first imaging modality in patients with suspicious complaints for BI and negative physical exam.
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Affiliation(s)
- Gilad Feinmesser
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel.
| | - Ana Eyal
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer 526200, Israel.
| | - Shai Shrot
- Sackler Faculty of Medicine, Tel Aviv University, 6997802, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer 526200, Israel
| | - Eugenia A Belenky
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer 526200, Israel.
| | - Jobran Mansour
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel; Sackler Faculty of Medicine, Tel Aviv University, 6997802, Israel
| | - Nir Livneh
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel
| | - Hadas Knoller
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel
| | - Hilla Schindel
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel
| | - Eran E Alon
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 526200, Israel; Sackler Faculty of Medicine, Tel Aviv University, 6997802, Israel.
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Huh JY. Foreign body aspirations in dental clinics: a narrative review. J Dent Anesth Pain Med 2022; 22:161-174. [PMID: 35693357 PMCID: PMC9171332 DOI: 10.17245/jdapm.2022.22.3.161] [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: 04/01/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Foreign body aspiration can produce a medical emergency. Obstruction of the airways can be life-threatening, and complications may develop in less-severe cases if it is left untreated. Although it is more prevalent in children by approximately three times, adults can still experience it, and it is more frequently related to healthcare in adults. Objects used in dental treatment are usually placed in the oral cavity and can be ingested or inhaled by accident. Dental treatment has been identified as an important cause of the misplacement of foreign bodies in the airway. However, few reports have been published on dentistry-related foreign body aspiration. This paper discusses the disease course, management, and clinical outcomes of foreign body aspiration, especially those associated with dentistry. The patient must be examined for respiratory distress. If the patient is unstable, urgent airway management and the maneuvers for removal should be performed. Radiographs and computed tomography can help identify and locate the object. The treatment of choice is often bronchoscopy, and both flexible and rigid endoscopes can be used depending on the situation. Preventive measures need to be implemented to avoid inhalation accidents given the potential consequences. Though the incidence is rare, healthcare levels need to be enhanced to avert morbidity and mortality. Radiological evaluation and bronchoscopy are vital for management.
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Affiliation(s)
- Jin-Young Huh
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Gwang-Myeong Hospital, Chung-Ang University College of Medicine, Gwang-Myeong, Republic of Korea
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10
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Something's "Fishy" With That Sore Throat... Adv Emerg Nurs J 2021; 43:198-205. [PMID: 34397496 DOI: 10.1097/tme.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 9-year old male presented to the emergency department for the evaluation of a sore throat. Initial history of present illness stated in the triage note was that "the child complained of a sore throat," suggesting possible pharyngitis. There was no evidence of stridor, sialorrhea, hypoxia, or aphonia. Further investigation of the history of present illness identified the concern for a possible esophageal foreign body. Imaging studies of the neck identified a fishbone in the esophagus. This case presentation discusses an atypical presentation of an esophageal foreign body and the subtle findings on assessment and imaging. This case highlights the importance of illiciting a history of present illness and the subtleties of esophageal foreign body identification.
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Internal Jugular Vein Injury by Fishbone Ingestion. Case Rep Med 2020; 2020:9182379. [PMID: 32636881 PMCID: PMC7321512 DOI: 10.1155/2020/9182379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/01/2020] [Indexed: 11/24/2022] Open
Abstract
Fishbone ingestion is a common occurrence in the Middle East countries. We present a patient with a unique complication of fishbone ingestion. A 65-year-old woman presented with left-sided neck pain and swelling since 5 days before admission. A linear foreign body with horizontal orientation was seen in CT scan at the superior part of the pharynx along with a collection around it which caused a laceration on the medial aspect of internal jugular vein and thrombosis inside the internal jugular vein.
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12
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Diagnostic Accuracy of Lateral Neck Radiography for Esophageal Foreign Bodies in Adults. AJR Am J Roentgenol 2020; 215:465-471. [PMID: 32406772 DOI: 10.2214/ajr.19.21870] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE. The objective of our study was to evaluate the accuracy of signs on lateral neck radiography for the assessment of patients with suspected esophageal foreign bodies (FBs). MATERIALS AND METHODS. This retrospective study was conducted of 235 adult patients between January 2012 and December 2017. Group 1 was composed of 95 patients with esophageal FBs, and group 2 was composed of 140 patients without esophageal FBs. Four signs on lateral neck radiography were recorded in both groups: presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, and increased prevertebral soft-tissue thickness. The prevertebral thickness was also evaluated in three groups of patients categorized by patient age: 19-29 years old, 30-59 years old, and 60 years old or older. RESULTS. The accuracy of the presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, and increased prevertebral soft-tissue thickness was 84.3%, 66.8%, 54.0%, and 60.9%, respectively. Combined two signs of presence of radiopaque density with air column lucency provided the highest accuracy, 90.6%. The prevertebral thickness at C6 of group 1 was 14.28 ± 3.19 mm (mean ± SD), and the prevertebral thickness at C6 of group 2 was 13.34 ± 2.54 mm (p = 0.018). CONCLUSION. Lateral neck radiography is helpful for the initial evaluation of patients with suspected esophageal FBs. The presence of radiopaque density or air column lucency provided the highest practical diagnostic value. Loss of cervical lordosis, as a single diagnostic sign, did not seem to provide a diagnostic advantage. Despite the variations in values for the three age groups, clinicians should be alert regarding increased prevertebral thickness at C6 especially when it is more than 20 mm.
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Ahn JH, Sohn Y. Application of point-of-care ultrasound for different types of esophageal foreign bodies: three case reports: A CARE-compliant article. Medicine (Baltimore) 2020; 99:e18893. [PMID: 31977900 PMCID: PMC7004603 DOI: 10.1097/md.0000000000018893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RATIONALE Esophageal point-of-care ultrasound (POCUS) has recently been reported as a useful, quick, safe, and simple technique to detect esophageal foreign bodies (FBs). However, case series to detect esophageal FB using POCUS have been rarely reported. Chicken bones and pills, especially, have not yet been reported as esophageal FBs. The objective of this case series was to describe the POCUS findings of 3 different materials-food, pill, and chicken bone. PATIENT CONCERNS Case 1, a 75-year-old woman with odynophagia and neck pain occurring 30 min after eating chicken porridge; Case 2, a 32-year-old woman with neck discomfort occurring 2 h after taking a pill; Case 3, a 29-year-old woman reporting FB sensation in the neck that occurred 1 h after eating sausage and rice soup. DIAGNOSIS Case 1. Cervical esophageal FB (chicken bone), Case 2. Cervical esophageal FB (oral pill), Case 3. Cervical esophageal FB (food). INTERVENTIONS Case 1. POCUS, urgent esophagogastroduodenoscopy (EGD) with alligator forceps. POCUS findings; hyperechoic material (suspected FB) that did not disappear by swallowing and esophageal dilatation with pooling of secretions. Case 2. POCUS. POCUS findings; hypoechoic material (suspected FB) that did not disappear by swallowing, and esophageal bulging above the FB, especially observed in the longitudinal view. Case 3. POCUS. POCUS findings; hyperechoic material (suspected FB) with reverberation artifact that did not disappear with swallowing efforts. Prior FB esophageal bulging with persistent air-fluid level was especially observed in the longitudinal view. OUTCOMES Case 1. FB was removed by EGD with alligator forceps. Case 2. Symptoms disappeared under observation without EGD. Follow-up POCUS revealed normalized bulging esophagus. Case 3. These symptoms improved after vomiting a large piece of food material. Three patients were discharged without complications. LESSONS In this case series, the impacted materials were chicken bone, pill, and food. However, POCUS findings were similar (esophageal dilation, hyperechoic or hypoechoic lesion with mixed echogenic contents in food or secretion, and no change with swallowing efforts). A longitudinal view was useful to assume the presence of cervical esophageal FB in all three cases. Thus, POCUS findings could be indirect signs of a FB in the esophagus.
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Affiliation(s)
- Jung Hwan Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon
| | - Youdong Sohn
- Department of Emergency Medicine, Seoul Metropolitan Government – Seoul National University Boramae Medical Center, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Emergency Medicine, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, UAE
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14
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Lee CH, Chen TH, Ko JY, Yeh TH, Hsu WC, Kang KT. Ear, nose, and throat foreign bodies in adults: A population-based study in Taiwan. J Formos Med Assoc 2019; 118:1290-1298. [PMID: 31133521 DOI: 10.1016/j.jfma.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 04/14/2019] [Accepted: 05/10/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND/PURPOSE This study performed a population-based analysis in the managements of adult ear, nose, and throat FBs in Taiwan. METHODS The Taiwan Longitudinal Health Insurance Database 2000 were used, which comprises 1,000,000 beneficiaries randomly sampled in 2000 with a follow-up period from 2000 to 2013. Patients aged >18 years with ear, nose, or throat FB were identified according to the International Codes of Diseases. RESULTS In total, 94,312 adults with ear (n = 21,786), nose (n = 1007), throat (n = 62,986), airway (n = 419), or esophageal (n = 8114) FB were identified. Emergency department visits were most common among patients with esophageal or airway FB (33.3% and 25.1%, respectively). X-rays were most commonly performed for patients with esophageal FB (44.8%), and computed tomography (CT) was most commonly used for those with airway FB (4.3%). Hospitalization rate was the highest among patients with airway FB (7.4%), followed by those with esophageal (3.0%) and nose (0.7%) FB. Patients with airway FBs corresponded with the highest rate of intensive care unit stay (58.1%), longest hospital stay (10.5 days), and highest in-hospital mortality rate (25.8%). A multiple logistic regression model indicated that old age, medical comorbidities, undergoing CT, and airway or esophageal FB were associated with hospitalization among adults with FB. CONCLUSION Disparities were identified in the treatment of ear, nose, and throat FB in adults. This study provides population-based data that may serve as a reference for otolaryngologists in clinical FB management.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan
| | - Te-Huei Yeh
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taiwan.
| | - Kun-Tai Kang
- Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
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15
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Pinto A, Russo A, Reginelli A, Iacobellis F, Di Serafino M, Giovine S, Romano L. Gunshot Wounds: Ballistics and Imaging Findings. Semin Ultrasound CT MR 2019; 40:25-35. [DOI: 10.1053/j.sult.2018.10.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Abstract
Fish bone ingestion is a common presentation in ENT. If not managed correctly, it can cause serious complications for the patient and dilemmas for the clinician. A 49-year-old Sri Lankan woman presented to the emergency department following shark bone ingestion with a 'pricking' sensation in her throat. After initial investigation, the bone migrated through to the sternocleidomastoid muscle. After surgical removal of the shark bone she went on to develop a large neck collection, which required surgical drainage. The careful attention to the patient's history and use of imaging facilitated treatment in this case of fish bone ingestion and management of the sequelae.
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Affiliation(s)
| | | | - Hoi-Yi Ching
- Princess Alexandra Hospital NHS Trust, Harlow, UK
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17
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Cianci P, Tartaglia N, Altamura A, Di Lascia A, Fersini A, Neri V, Ambrosi A. Cervical Esophagotomy for Foreign Body Extraction: A Case Report and Extensive Literature Review of the Last 20 Years. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:400-405. [PMID: 29618719 PMCID: PMC5900799 DOI: 10.12659/ajcr.908373] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Voluntary and involuntary ingestion of foreign bodies is a common condition; in most cases they pass through the digestive tract, but sometimes they stop, creating emergency situations for the patient. We report a case of meat bolus with cartilaginous component impacted in the cervical esophagus, with a brief literature review. CASE REPORT A 64-year-old man came to our attention for retention in the cervical esophagus of a piece of meat accidentally swallowed during lunch. After a few attempts of endoscopic removal carried out previously in other hospitals, the patient has been treated by us with a cervical esophagotomy and removal of the foreign body, without any complications. We checked the database of PubMed, Scopus, and the Cochrane Library from January 2007 to January 2017 in order to verify the presence of randomized controlled trials, clinical trials, retrospective studies, and case series regarding the use of the cervical esophagotomy for the extraction of foreign bodies impacted in the esophagus. CONCLUSIONS The crucial point is to differentiate the cases that must be immediately treated from those requiring simple observation. Endoscopic treatment is definitely the first therapeutic option, but in case of failure of this approach, in our opinion, cervical esophagotomy could be a safe, easy, viable, durable approach for the extraction of foreign bodies impacted in the cervical esophagus. Our review does not have the purpose of providing definitive conclusions but is intended to represent a starting point for subsequent studies.
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18
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Laya BF, Restrepo R, Lee EY. Practical Imaging Evaluation of Foreign Bodies in Children. Radiol Clin North Am 2017; 55:845-867. [DOI: 10.1016/j.rcl.2017.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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19
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Oncel M, Sunam GS, Elsurer C, Yildiran H. Use of Magill Forceps to Remove Foreign Bodies in Children. Surg J (N Y) 2017; 3:e91-e95. [PMID: 28825029 PMCID: PMC5553505 DOI: 10.1055/s-0037-1604102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 04/17/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction
Esophageal foreign body (FB) in all age groups can cause serious morbidity or mortality. The study aims to report our experience retrieving FBs from the upper esophagus in children using Magill forceps.
Materials and Methods
In this study, 88 patients (45 males [51.1%] and 43 females [48.9%]) were presented with suspected FB ingestion. FB ingestion was determined via endoscopic analysis, or lateral and posterior–anterior radiographies, including oropharynx, neck, chest, and abdomen. Cases were classified into seven groups, according to history, diagnostic method, and postintervention findings, as follows: (1) coins, (2) toys, (3) metals, (4) bones, (5) battery, (6) glass, and (7) food. A laryngoscope was used to elevate the larynx and expose the esophageal entrance. Magill forceps were advanced into the esophagus and opened to observe and extract the FB.
Results
All 88 patients who underwent endoscopic examination due to suspected FB ingestion were confirmed to have ingested a FB. Median age was 12 years; 15 patients were aged < 5 years; 63 (71.5%) were diagnosed based on routine radiographic findings, and others were diagnosed based on physical findings and history. The most common type of FB was coins (
n
= 51 [57.9%]). Mean surgical duration was 20 minutes.
Conclusion
FBs located at cervical esophageal level are usually the most difficult to remove. Magill forceps should be used before other methods.
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Affiliation(s)
- Murat Oncel
- Department of Thoracic Surgery, Medical Faculty, Selcuk University, Konya, Turkey
| | - Guven Sadi Sunam
- Department of Thoracic Surgery, Medical Faculty, Selcuk University, Konya, Turkey
| | - Cagdas Elsurer
- Department of Otorhinolaryngology, Medical Faculty, Selcuk University, Konya, Turkey
| | - Huseyin Yildiran
- Department of Thoracic Surgery, Medical Faculty, Selcuk University, Konya, Turkey
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20
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Bedside sonography for the diagnosis of esophageal food impaction. Am J Emerg Med 2017; 35:720-724. [DOI: 10.1016/j.ajem.2017.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/15/2016] [Accepted: 01/07/2017] [Indexed: 01/08/2023] Open
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21
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Predictive parameters of retained foreign body presence after foreign body swallowing. Am J Emerg Med 2017; 35:1090-1094. [PMID: 28318803 DOI: 10.1016/j.ajem.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/07/2017] [Accepted: 03/01/2017] [Indexed: 11/23/2022] Open
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22
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Castán Senar A, Dinu LE, Artigas JM, Larrosa R, Navarro Y, Angulo E. Foreign Bodies on Lateral Neck Radiographs in Adults: Imaging Findings and Common Pitfalls. Radiographics 2017; 37:323-345. [DOI: 10.1148/rg.2017160073] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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23
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Hosokawa T, Yamada Y, Sato Y, Tanami Y, Nanbu R, Hagiwara SI, Oguma E. Role of Sonography for Evaluation of Gastrointestinal Foreign Bodies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2723-2732. [PMID: 27872423 DOI: 10.7863/ultra.16.01042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/13/2016] [Accepted: 03/18/2016] [Indexed: 06/06/2023]
Abstract
Foreign body ingestion is frequently encountered in children. The locations of the foreign bodies and the period during which they have been present in the thorax and abdomen are important for determining the method and timing of treatment. Although plain radiography and computed tomography are primarily used for assessment of foreign bodies, sonography without radiation is also useful for diagnosis of foreign bodies. This report describes 5 cases of foreign bodies in the digestive tract and the usefulness of sonography for real-time evaluation of foreign bodies with high spatial resolution. Physicians can use sonography along with radiography and computed tomography in cases involving foreign bodies.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryosuke Nanbu
- Department of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| | - Shin-Ichiro Hagiwara
- Department of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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24
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Wright B, Leyden P. Oesophageal foreign body: the importance of imaging in multiple coin ingestion. BMJ Case Rep 2016; 2016:bcr-2016-218040. [PMID: 27803088 DOI: 10.1136/bcr-2016-218040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Brendan Wright
- Department of ENT, Health and Social Care Services in Northern Ireland, Belfast, UK
| | - Peter Leyden
- Department of ENT, Southern Health and Social Care Trust, Portadown, UK
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25
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Cervical Osteophytes Increase the Risk for Foreign Body Impaction: A 171-Patient Case–Control Study. Dysphagia 2016; 31:749-756. [DOI: 10.1007/s00455-016-9731-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 07/18/2016] [Indexed: 01/19/2023]
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26
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Guelfguat M, Dipoce J, Dipoce J. A dental nightmare, resolved: what a radiologist needs to know when consulted about ingestion of dental foreign body material. BJR Case Rep 2016; 2:20150166. [PMID: 30363664 PMCID: PMC6180876 DOI: 10.1259/bjrcr.20150166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 11/24/2015] [Accepted: 11/30/2015] [Indexed: 01/08/2023] Open
Abstract
Ingestion of dental foreign bodies, while relatively rare, may cause serious, and occasionally fatal, injuries to the airways and gastrointestinal tract. Numerous case reports are available describing the clinical course of such ingestions. The aim of this paper is to develop concise, practical recommendations to aid radiologists in providing clinically relevant diagnostic information, thereby accelerating detection and management of acute ingestion of dental material.
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Affiliation(s)
| | - Jason Dipoce
- Department of Radiology, Hadassah Medical Center, Jerusalem, Israel
| | - James Dipoce
- Department of Radiology, Staten Island University Hospital, New York, NY, USA
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27
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Liguori C, Gagliardi N, Saturnino PP, Pinto A, Romano L. Multidetector Computed Tomography of Pharyngo-Esophageal Perforations. Semin Ultrasound CT MR 2016; 37:10-5. [DOI: 10.1053/j.sult.2015.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Temiz A. Efficiency of upper gastrointestinal endoscopy in pediatric surgical practice. World J Clin Pediatr 2015; 4:113-119. [PMID: 26566483 PMCID: PMC4637801 DOI: 10.5409/wjcp.v4.i4.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/17/2015] [Accepted: 08/14/2015] [Indexed: 02/06/2023] Open
Abstract
After the introduction of flexible fiber optic endoscopy to pediatric gastroenterology in the 1970s, upper gastrointestinal (UGI) endoscopy can be performed for the diagnosis and treatment of all age groups of children. We review indications, contraindications, preparation of patients for the procedure, and details of diagnostic and therapeutic UGI endoscopy used in pediatric surgery. We also discuss potential complications of endoscopy.
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29
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Faggian A, Berritto D, Iacobellis F, Reginelli A, Cappabianca S, Grassi R. Imaging Patients With Alimentary Tract Perforation: Literature Review. Semin Ultrasound CT MR 2015; 37:66-9. [PMID: 26827740 DOI: 10.1053/j.sult.2015.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Alimentary tract perforation is a frequent emergency condition. Imaging plays an important role to make an accurate diagnosis, defining the presence, the level, and the cause of the perforation, essential information to enable the most correct therapeutic choice. Plain radiography is generally performed as the first choice. In case of a clinically suspected bowel perforation, not detected on x-ray imaging, the contribution of computed tomography is essential. Magnetic resonance is not yet widely used in diagnostic workup of patients with acute abdominal pain, but it can be useful in the differential diagnosis of acute abdomen in specific patients (pregnancy and pediatric patients).
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Affiliation(s)
- Angela Faggian
- Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Daniela Berritto
- Institute of Radiology, Second University of Naples, Naples, Italy
| | | | | | | | - Roberto Grassi
- Institute of Radiology, Second University of Naples, Naples, Italy
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30
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Pugmire BS, Lim R, Avery LL. Review of Ingested and Aspirated Foreign Bodies in Children and Their Clinical Significance for Radiologists. Radiographics 2015; 35:1528-38. [PMID: 26295734 DOI: 10.1148/rg.2015140287] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ingested and aspirated foreign bodies are a common occurrence in children and are important causes of morbidity and mortality in the pediatric population. Imaging plays an important role in the diagnosis of ingested and aspirated foreign bodies in children and can be crucial to guiding the clinical management of these patients. Prompt identification and localization of ingested foreign bodies is essential to determining the appropriate treatment, as several types of commonly ingested foreign bodies require urgent removal and others can be managed conservatively. In particular, disk batteries impacted in the esophagus carry a high risk of esophageal injury or perforation; multiple ingested magnets can become attracted to each other across bowel walls and cause bowel perforation and fistula formation; and sharp objects commonly cause complications as they pass through the gastrointestinal tract. Accordingly, these ingested foreign bodies warrant aggressive clinical management and therefore radiologists must be familiar with their imaging appearances and clinical implications. Prompt recognition of secondary radiographic signs of foreign-body aspiration is also crucial, as clinical symptoms can sometimes be nonspecific and most aspirated foreign bodies are radiolucent. Overall, radiography is the most important modality in the evaluation of ingested or aspirated foreign bodies; however, fluoroscopy and computed tomography play an ancillary role in complicated cases. It is essential that every radiologist who interprets imaging examinations of children be aware of the imaging appearances of commonly ingested and aspirated foreign bodies and their clinical significance.
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Affiliation(s)
- Brian S Pugmire
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 (B.S.P.) and the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, Mass (R.L., L.L.A.)
| | - Ruth Lim
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 (B.S.P.) and the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, Mass (R.L., L.L.A.)
| | - Laura L Avery
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 (B.S.P.) and the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, Mass (R.L., L.L.A.)
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31
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Tseng CC, Hsiao TY, Hsu WC. Comparison of rigid and flexible endoscopy for removing esophageal foreign bodies in an emergency. J Formos Med Assoc 2015; 115:639-44. [PMID: 26142485 DOI: 10.1016/j.jfma.2015.05.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/PURPOSE Despite the effectiveness of endoscopies in removing ingested foreign bodies (FBs) impacted in the esophagus, the merits and limitations of flexible endoscopy (FE) and rigid endoscopy (RE) remain unclear. Therefore, this study compares the advantages and disadvantages of both endoscopic procedures from a clinical perspective. METHODS A retrospective review was made of 273 patients suspected of esophageal FBs in emergency consultations of a tertiary medical referral center from March 2010 to March 2014. All patients received routine physical examinations, otolaryngological examinations, and X-rays of the neck and chest. The door-to-endoscopy time, procedure time, postendoscopic hospital stay, successful removal rates, and complications were analyzed as well. RESULTS In this study, the most common esophageal FBs were fish and animal bones (76%) in adults and coins (74%) in children. The patients with existing esophageal FBs had significantly more frequent symptoms of dysphagia and signs of linear opacity as detected with lateral neck radiography than those without FB. Additionally, the door-to-endoscopy time, procedure time, and postendoscopic hospital stay was significantly shorter in FE patients than in RE patients. However, both RE and FE patients had high rates of successful FB removal (95%) and low complication rates (2%). CONCLUSION Both FE and RE remove esophageal FBs successfully, as evidenced by their high success rates, low complication rates, and high detection rates. Although FE under local anesthesia is a less time-consuming procedure for adults, RE under general anesthesia may be preferable for children and can serve as an alternative to FE.
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Affiliation(s)
- Chia-Chen Tseng
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Yu Hsiao
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
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32
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Sharp penetrating wounds: spectrum of imaging findings and legal aspects in the emergency setting. Radiol Med 2015; 120:856-65. [PMID: 26032854 DOI: 10.1007/s11547-015-0553-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
The main cause of severe civilian trauma is not the same all over the world; while in Europe the majority of cases are due to blunt traumatic injury, in the United States, penetrating gunshot wounds are the most common. Penetrating wounds can be classified into two different entities: gunshot wounds, or more technically ballistic traumas, and sharp penetrating traumas, also identifiable with non-ballistic traumas. Sharp penetrating injuries are mainly caused by sharp pointed objects such as spears, nails, daggers, knives, and arrows. The type of injuries caused by sharp pointed objects depends on the nature and shape of the weapon, the amount of energy in the weapon or implement when it strikes the body, whether it is inflicted upon a moving or a still body, and the nature of the tissue injured. In the assessment of hemodynamically stable patients with sharp penetrating wounds, the main imaging procedure is Multidetector Computed Tomography (MDCT), especially used in complicated cases of penetrating injuries with an important impact on the final therapeutic choice. The diagnostic approach has been changed by MDCT due to its technical improvements, in particular, faster data acquiring and upgraded image reconstructions.
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33
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Woo SH, Kim KH. Proposal for methods of diagnosis of fish bone foreign body in the Esophagus. Laryngoscope 2015; 125:2472-5. [PMID: 25962971 DOI: 10.1002/lary.25340] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/24/2015] [Accepted: 03/26/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the methods of diagnosis of fish bone foreign body in the esophagus and suggest a diagnostic protocol. STUDY DESIGN Prospective cohort study. METHODS A prospective study was performed on 286 patients with a history of fish bone foreign body impaction. Among them, 88 patients had negative findings in the oral cavity and laryngopharynx. Subsequent radiologic assessment of these patients included plain radiography and computed tomography (CT). Sixty-six patients showed positive findings in the esophagus, and an attempt was made to remove the obstruction using transnasal esophagoscopy. RESULTS In 66 patients, a fish bone foreign body was detected in the esophagus by CT. In contrast, plain radiography detected a foreign body in only 30 patients. The overall detection rate of plain radiography compared with CT for fish bones was 45.5%. Plain radiography detected 35.9% of the simple type fish bones and 54.5% of the gill bone detected by CT. However, jaw bones had a detection rate of 100% with both methods. The fish bone foreign bodies were most commonly located in the upper esophagus (n=65, 98.5%), followed by the lower esophagus (n=1, 1.5%). CONCLUSION CT is a useful method for identification of esophageal fish bone foreign bodies. Therefore, CT should be considered as the first-choice technique for the diagnosis of esophageal fish bone foreign body. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Seung Hoon Woo
- Department of Otorhinolaryngology, Gyeongsang National University, Jinju, Republic of Korea.,the Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Kyung Hee Kim
- College of Nursing, Gyeongsang National University, Jinju, Republic of Korea
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34
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Tang SJ, Wu R. Esophageal introitus (with videos). Gastrointest Endosc 2015; 81:270-81. [PMID: 25616751 DOI: 10.1016/j.gie.2014.09.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/29/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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35
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Pinto A, Miele V, Pinto F, Mizio VD, Panico MR, Muzj C, Romano L. Rectal Foreign Bodies: Imaging Assessment and Medicolegal Aspects. Semin Ultrasound CT MR 2015; 36:88-93. [DOI: 10.1053/j.sult.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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36
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Grassi R, Faggian A, Somma F, De Cecco CN, Laghi A, Caseiro-Alves F. Application of imaging guidelines in patients with foreign body ingestion or inhalation: literature review. Semin Ultrasound CT MR 2014; 36:48-56. [PMID: 25639177 DOI: 10.1053/j.sult.2014.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ingestion, inhalation, and insertion of foreign bodies (FBs) are very common clinical occurrences. In any case, early diagnosis and prompt management are mandatory to avoid severe and life-threatening complications. Radiologists have an important role in revealing the presence, dimension, nature, and relationship with anatomical structures of a FB; selecting the most appropriate imaging modality; and enabling the best therapeutic choice. This review article focuses on the most frequent FBs ingested, inhaled, and inserted and presents the different tests and investigations to provide a correct radiological approach.
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Affiliation(s)
- Roberto Grassi
- Institute of Radiology, Second University of Naples, Naples, Italy
| | - Angela Faggian
- Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Francesco Somma
- Institute of Radiology, Second University of Naples, Naples, Italy
| | - Carlo Nicola De Cecco
- Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza, Latina, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology, University of Rome Sapienza, Latina, Italy
| | - Filipe Caseiro-Alves
- Universitary Clinic of Radiology, Coimbra University Hospitals, Coimbra, Portugal
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Pinto A, Lanza C, Pinto F, Grassi R, Romano L, Brunese L, Giovagnoni A. Role of plain radiography in the assessment of ingested foreign bodies in the pediatric patients. Semin Ultrasound CT MR 2014; 36:21-7. [PMID: 25639174 DOI: 10.1053/j.sult.2014.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ingestion of various types of foreign bodies (FBs) such as coins, toy parts, jewelry pieces, needles and pins, fish and chicken bones, and button-type batteries is common among children. The curiosity of children and their need to investigate the world around them place them at a higher risk for ingestion of FBs. Fortunately, 80%-90% of ingested foreign objects that reach the stomach will pass uneventfully without intervention. The remainder may become blocked in the esophagus or other region of the alimentary tract, placing the pediatric patient at risk of significant complications such as aspiration, obstruction, bleeding, perforation, fistulization, sepsis, and death. The goals of the initial pediatric patient assessment are to identify the type of object ingested, its location in the gastrointestinal tract, and the presence of associated complications. Factors reported to increase the risk of complications included a sharp FB, a FB with a wide diameter, and symptoms. Plain radiographs still play an important role in the assessment of ingested FBs in the pediatric patient: plain films of the neck, chest, and abdomen are very useful in confirming the diagnosis of FB ingestion because most ingested FBs are radiopaque.
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Affiliation(s)
- Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy.
| | - Cecilia Lanza
- Department of Radiology, Unit of General and Pediatric Radiology, University Politecnica delle Marche, Hospital Torrette-Lancisi-Salesi, Ancona, Italy
| | - Fabio Pinto
- Department of Diagnostic Radiological Imaging, Marcianise Hospital, Marcianise (CE), Italy
| | - Roberta Grassi
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy
| | - Luigia Romano
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Luca Brunese
- Department of Health Science, University of Molise, Campobasso, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Unit of General and Pediatric Radiology, University Politecnica delle Marche, Hospital Torrette-Lancisi-Salesi, Ancona, Italy
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Abstract
OBJECTIVE The purpose of this article is to familiarize radiologists with the specific characteristics of foreign bodies, obtained from image interpretation, to guide further management. Details of object morphologic characteristics and location in the body gained through imaging form the backbone of the classification used in the treatment of ingested foreign bodies. CONCLUSION The characteristics of foreign bodies and predisposing bowel abnormalities affect the decision to follow ingested objects radiographically, perform additional imaging, or proceed with endoscopic or surgical removal.
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Giannitto C, Esposito AA, Casiraghi E, Biondetti PR. Epidemiological profile of non-traumatic emergencies of the neck in CT imaging: our experience. Radiol Med 2014; 119:784-9. [PMID: 24553784 DOI: 10.1007/s11547-014-0389-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was undertaken to collect information on the incidence and distribution of acute, non-traumatic conditions of the neck at our emergency radiology department and to review the literature about this topic. MATERIALS AND METHODS We retrospectively reviewed 143 consecutive patients who underwent neck computed tomography (CT) for non-traumatic emergencies between 1 December 2008 and 31 December 2012. For each of the conditions identified, we defined the overall incidence, the incidence based on the site, gender, average age and age range. RESULTS Computed tomography examination was positive in 125 out of 143 patients (87.4%), 74 men and 51 women, with an average age of 51.1 years, aged between 10 and 90 years. We found 79 inflammatory/infectious conditions (63.2% of positive cases, 55.2% of total cases), 46 men and 33 women, with an average age of 47 years. Computed tomography revealed 26 newly found tumours (20.8/18.2%), 19 men and 7 women, with an average age of 68.5 years, aged between 49 and 97 years. In 20 cases, 9 men and 11 women, with an average age of 57.3 years, aged between 21 and 90 years, we diagnosed other acute conditions: six cases of foreign body ingestion (4.8/4.2%), five benign swellings (4/3.5%), five cases of vascular disorders (4/3.5%), and four cases of oedema of the larynx (3.2/2.8 %). CONCLUSIONS Our study of emergency CT of non-traumatic conditions of the neck fundamentally revealed infectious/inflammatory diseases and newly found neoplasms.
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Pinto A, Reginelli A, Pinto F, Sica G, Scaglione M, Berger FH, Romano L, Brunese L. Radiological and practical aspects of body packing. Br J Radiol 2014; 87:20130500. [PMID: 24472727 DOI: 10.1259/bjr.20130500] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Body packing represents the concealment of illegal substances in a person's body with the aim of smuggling. "Body packers" either swallow drug-filled packets or introduce drug-filled packets into their bodies rectally or vaginally with the purpose of concealing them. The three main smuggled drugs are cocaine, heroin and cannabis products. Body packing represents a serious risk of acute narcotic toxicity from drug exposure, intestinal obstruction owing to pellet impaction and bowel perforation with consequent abdominal sepsis. A suspected body packer is generally admitted to hospital to perform imaging investigations and confirm the presence of drugs in his/her body. Radiological imaging methods are essential to diagnose body packing and to detect potential complications. Increasing sophistication of traffickers and improvements in packaging add to the detection difficulty. Radiologists should be aware of the appearance of drug packets in a range of imaging modalities. This article informs physicians about the challenging aspects of body packing, its background and medicolegal issues, what imaging methods can be used and what criteria are necessary to perform a correct diagnosis.
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Affiliation(s)
- A Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
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Park S, Choi DS, Shin HS, Cho JM, Jeon KN, Bae KS, Koh EH, Park JJ. Fish bone foreign bodies in the pharynx and upper esophagus: evaluation with 64-slice MDCT. Acta Radiol 2014; 55:8-13. [PMID: 23884842 DOI: 10.1177/0284185113493087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Fish bone (FB) is one of the common causes of foreign body impaction in the pharynx and esophagus. PURPOSE To investigate the efficacy of 64-slice multidetector computed tomography (MDCT) for the evaluation of pharynx and upper esophageal FB foreign bodies. MATERIAL AND METHODS Sixty-six patients with suspected FB foreign body ingestion were examined by plain radiography (n = 40) and unenhanced MDCT (n = 66). We analyzed the presence, location, size, shape, and lying position of the foreign bodies. RESULTS On MDCT, 46 foreign bodies were detected. Among them, 45 were confirmed by endoscopy. The sensitivity of MDCT for the detection of foreign bodies was 100%, which was superior to that of the plain radiography (51.7%). The location of the foreign bodies was most common in the upper esophagus (n = 22, 47.8%), followed by pharyngoesophageal junction (n = 10, 21.7%), transjunctional (n = 7, 15.2%), hypopharynx (n = 5, 10.9%), and oropharynx (n = 2, 4.3%). Their longest length was 5.3-40.1 mm (mean, 21.3 mm). Thirty-three FBs (71.7%) were linear and 13 (28.3%) were flat in shape. They showed transverse (n = 23, 50.0%), parallel (n = 13, 28.3%), and oblique positions (n = 10, 21.7%) to the long axis of the pharynx and esophagus, respectively. CONCLUSION MDCT is useful for the evaluation of the pharynx and upper esophageal FB foreign bodies.
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Affiliation(s)
- Soyeon Park
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Hwa Seon Shin
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jae Min Cho
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Kyung-Soo Bae
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Eun Ha Koh
- Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jung Je Park
- Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Chiou YL. A hook in the esophagus. QJM 2014; 107:163. [PMID: 23345465 DOI: 10.1093/qjmed/hct020] [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] [Indexed: 11/13/2022] Open
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Abstract
Acute obstruction of the gastrointestinal or biliary tract represents a common problem for acute care surgeons. It is with appropriate clinical evaluation, planning, and physical examination follow-up that acute care surgeons are able to appropriately diagnose, manage, and resolve this difficult group of surgical problems and minimize the morbidity associated with each.
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Affiliation(s)
- Jason Sperry
- University of Pittsburgh Medical Center, Suite F1268 PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Triadafilopoulos G, Roorda A, Akiyama J. Update on foreign bodies in the esophagus: diagnosis and management. Curr Gastroenterol Rep 2013; 15:317. [PMID: 23435762 DOI: 10.1007/s11894-013-0317-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Foreign body impaction in the esophagus is an important emergency that carries significant morbidity and potential mortality. The most common cause of esophageal foreign body obstruction in adults is meat bolus impaction above a pre-existing distal esophageal (mucosal) ring, peptic or malignant esophageal stricture, or eosinophilic esophagitis. Immediate evaluation of the airway, assessment of the urgency of removal, radiological evaluation to localize the object, endoscopic or surgical retrieval, and subsequent monitoring for complications are essential steps in the management.
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