The lateral neck radiograph in suspected impacted fish bones — Does it have a role?

doi:10.1016/S0009-9260(05)80316-2

Clinical Radiology

Volume 46, Issue 2, August 1992, Pages 121-123

https://doi.org/10.1016/S0009-9260(05)80316-2 Get rights and content

A double blind trial, using lateral neck radiographs of 100 patients with proven impacted fish bones and 100 normal cases, was conducted to assess the sensitivity, specificity and positive predictive value of radiography for impacted fish bones. Values of 25.3%, 86.3% and 72.7% respectively were obtained. The results are correlated to the clinical findings and reasons for the poor performance of radiography are discussed. It is recommended that routine radiography for suspected impacted fish bones should be abandoned.

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Citation Excerpt :
When esophageal foreign body is suspected, a plain x-ray study of the neck and chest should be obtained, as this is considered the preferred imaging choice due to convenience, low cost, and minimal radiation exposure. However, the sensitivity of lateral neck radiograph for foreign body is low and one study found that results can be normal in 47% of all foreign body cases and 87% of cases where the foreign body is a nonboney food bolus (7,8). If the radiograph is inconclusive but foreign body is still suspected, it can be followed by barium swallow, although this is losing popularity.
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.
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.
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.
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Original PaperThe lateral neck radiograph in suspected impacted fish bones — Does it have a role?

Clinical Radiology

Foreign bodies in the oesophagus: review of 2,394 cases

British Journal of Surgery

Foreign bodies in the throat: a prospective study of 388 cases

Journal of Laryngology and Otology

Swallowed foreign bodies

Journal of Laryngology and Otology

Original Paper
The lateral neck radiograph in suspected impacted fish bones — Does it have a role?