Bones tend to lodge in cervical esophagus, just below level of cricopharyngeus muscle (C6 level)
Ingested bone fragments: Linear or slightly curved
Diffuse widening of retropharyngeal soft tissue
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Large food bolus; unchewed meat
Above stricture, Schatzki ring, or tumor
Barium-soaked cotton ball, marshmallow; helps identify nonopaque, small FB
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Follow-up esophagram after removal of FB
Underlying disease, motor function, patency
Check for injury to esophagus
TOP DIFFERENTIAL DIAGNOSES
CLINICAL ISSUES
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Majority occur in children
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High-risk adults include
Mentally impaired
Those with esophageal motility or morphologic abnormalities
Those who habitually hold nails or pins with their lips
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Management depends on type, size, location of FB
Most FB pass spontaneously
Disk batteries are toxic and should be removed
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Endoscopic extraction: Flexible fiberoptic
Successful removal rates as high as 92-98%, with uncommon complications
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Fluoroscopically guided: Balloon-tipped Foley or Fogarty catheter; Dormia-type wire basket
TERMINOLOGY
Abbreviations
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Esophageal foreign body (FB)
Definitions
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Ingested FB impacted within esophagus
IMAGING
General Features
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Best diagnostic clue
History of ingestion followed by dysphagia or odynophagia
Related
Diagnostic Imaging_ Gastrointes - Michael P Federle