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Pham ST, Sakai O, Andreu-Arasa VC. Imaging approach to ingested foreign bodies in the neck. Neuroradiology 2024; 66:867-881. [PMID: 38619570 DOI: 10.1007/s00234-024-03348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
Foreign body ingestion is a common clinical occurrence worldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck.
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Affiliation(s)
- Serena T Pham
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Osamu Sakai
- Division of Neuroradiology, Department of Radiology, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - V Carlota Andreu-Arasa
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, MA, USA.
- Division of Neuroradiology, Department of Radiology, VA Boston Healthcare System, Boston, MA, USA.
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Chen YS, Luo SD, Lee CH, Lin JF, Lin TY, Ko SF, Yu CC, Chiang PL, Wang CK, Chiu IM, Huang YT, Tai YF, Chiang PT, Lin WC. Improving detection of impacted animal bones on lateral neck radiograph using a deep learning artificial intelligence algorithm. Insights Imaging 2023; 14:43. [PMID: 36929090 PMCID: PMC10020388 DOI: 10.1186/s13244-023-01385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/04/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE We aimed to develop a deep learning artificial intelligence (AI) algorithm to detect impacted animal bones on lateral neck radiographs and to assess its effectiveness for improving the interpretation of lateral neck radiographs. METHODS Lateral neck radiographs were retrospectively collected for patients with animal bone impaction between January 2010 and March 2020. Radiographs were then separated into training, validation, and testing sets. A total of 1733 lateral neck radiographs were used to develop the deep learning algorithm. The testing set was assessed for the stand-alone deep learning AI algorithm and for human readers (radiologists, radiology residents, emergency physicians, ENT physicians) with and without the aid of the AI algorithm. Another radiograph cohort, collected from April 1, 2020, to June 30, 2020, was analyzed to simulate clinical application by comparing the deep learning AI algorithm with radiologists' reports. RESULTS In the testing set, the sensitivity, specificity, and accuracy of the AI model were 96%, 90%, and 93% respectively. Among the human readers, all physicians of different subspecialties achieved a higher accuracy with AI-assisted reading than without. In the simulation set, among the 20 cases positive for animal bones, the AI model accurately identified 3 more cases than the radiologists' reports. CONCLUSION Our deep learning AI model demonstrated a higher sensitivity for detection of animal bone impaction on lateral neck radiographs without an increased false positive rate. The application of this model in a clinical setting may effectively reduce time to diagnosis, accelerate workflow, and decrease the use of CT.
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Affiliation(s)
- Yueh-Sheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chi-Hsun Lee
- Next E-Commerce Technology Co., LTD., Taichung, Taiwan
| | - Jian-Feng Lin
- Next E-Commerce Technology Co., LTD., Taichung, Taiwan
| | - Te-Yen Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Sheung-Fat Ko
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Chiun-Chieh Yu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - I-Min Chiu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yii-Ting Huang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yi-Fan Tai
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Po-Teng Chiang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan. .,Department of Radiology, Jen Ai Chang Gung Health, Dali Branch, Taichung, Taiwan.
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Idris F, Kin FS, Zaki FBM, Baki MM. Challenging Removal of Embedded Fishbone in Tongue: Multimodal Technique, Surgical Approach and Consideration of Migration. Turk Arch Otorhinolaryngol 2022; 60:59-62. [PMID: 35634231 PMCID: PMC9103568 DOI: 10.4274/tao.2021.2021-6-5] [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: 06/17/2021] [Accepted: 09/19/2021] [Indexed: 12/01/2022] Open
Abstract
Fishbone ingestion is a common occurrence and patients present with various symptoms, posing challenges to the attending physicians. Here, we present two unique cases of patients with an unexpected rapidly migrating fishbone in the tongue. The first patient was operated transorally because of a foreign body embedded in the genioglossus muscle. In the second patient, CT scan located a fishbone embedded in the left hyoglossus muscle; however, the fishbone had to be relocated intraoperatively using bedside ultrasound guidance and was eventually found embedded within the mylohyoid muscle. The fishbone was successfully removed via transcervical approach following a failed transoral approach.
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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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Yang TW, Yu YC, Lin YY, Hsu SC, Chu KCW, Hsu CW, Bai CH, Chang CK, Hsu YP. Diagnostic Performance of Conventional X-ray for Detecting Foreign Bodies in the Upper Digestive Tract: A Systematic Review and Diagnostic Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11050790. [PMID: 33925749 PMCID: PMC8145745 DOI: 10.3390/diagnostics11050790] [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: 03/14/2021] [Revised: 04/11/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023] Open
Abstract
Foreign body (FB) ingestion is a common clinical problem in acute settings. Detecting FBs in the upper digestive tract is challenging. The conventional X-ray is usually the first-line imaging tool to detect FBs. However, its diagnostic performance is inconsistent in the literature. In this study, we performed a systematic review and meta-analysis to determine the diagnostic performance of the conventional X-ray for detecting FBs in the upper digestive tract. We conducted a systematic search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus until 1 August 2020. Prospective or retrospective studies investigating the diagnostic accuracy of conventional X-rays for detecting FBs in the upper digestive tract in patients of all ages were included. The Quality Assessment of Studies of Diagnostic Accuracy-2 tool was used to review the quality of included studies. We used a bivariate random-effects model to calculate diagnostic accuracy parameters. Heterogeneity was assessed using I2 statistics. We included 17 studies (n = 4809) in the meta-analysis. Of the 17 studies, most studies were rated as having a high risk of bias. Conventional X-rays had a pooled sensitivity of 0.58 (95% confidence interval [CI] = 0.36–0.77, I2 = 98.52) and a pooled specificity of 0.94 (95% CI = 0.87–0.98, I2 = 94.49) for detecting FBs in the upper digestive tract. The heterogeneity was considerable. The area under the summary receiver operating characteristic curve was 0.91 (95% CI = 0.88–0.93). Deek’s funnel plot asymmetry test results revealed no significant publication bias (p = 0.41). The overall sensitivity and specificity of conventional X-rays were low and high, respectively, for detecting FBs in the upper digestive tract. Hence, conventional X-rays to exclude patients without upper FBs in the digestive tract are not recommended. Further imaging or endoscopic examinations should be performed for at-risk patients.
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Affiliation(s)
- Ta-Wei Yang
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan; (T.-W.Y.); (Y.-Y.L.)
- National Defense Medical Center, Taipei 114, Taiwan
| | - Yi-Chung Yu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-C.Y.); (S.-C.H.); (K.C.-W.C.); (C.-W.H.)
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Yen-Yue Lin
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan; (T.-W.Y.); (Y.-Y.L.)
- National Defense Medical Center, Taipei 114, Taiwan
| | - Shih-Chang Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-C.Y.); (S.-C.H.); (K.C.-W.C.); (C.-W.H.)
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Karen Chia-Wen Chu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-C.Y.); (S.-C.H.); (K.C.-W.C.); (C.-W.H.)
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chin-Wang Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-C.Y.); (S.-C.H.); (K.C.-W.C.); (C.-W.H.)
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - Cheng-Kuang Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Yuan-Pin Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-C.Y.); (S.-C.H.); (K.C.-W.C.); (C.-W.H.)
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Correspondence: ; Tel.: +886-963-637-073
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