Esophageal Foreign Body

Published on 06/08/2015 by admin

Filed under Radiology

Last modified 06/08/2015

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 Bones tend to lodge in cervical esophagus, just below level of cricopharyngeus muscle (C6 level)

image Ingested bone fragments: Linear or slightly curved
image Diffuse widening of retropharyngeal soft tissue
• Large food bolus; unchewed meat

image Above stricture, Schatzki ring, or tumor
image Barium-soaked cotton ball, marshmallow; helps identify nonopaque, small FB
• Follow-up esophagram after removal of FB

image Underlying disease, motor function, patency
image Check for injury to esophagus

TOP DIFFERENTIAL DIAGNOSES

• Esophageal carcinoma
• Esophagitis

CLINICAL ISSUES

• Majority occur in children
• High-risk adults include

image Mentally impaired
image Those with esophageal motility or morphologic abnormalities
image Those who habitually hold nails or pins with their lips
• Management depends on type, size, location of FB

image Most FB pass spontaneously
image Disk batteries are toxic and should be removed
• Endoscopic extraction: Flexible fiberoptic

image Successful removal rates as high as 92-98%, with uncommon complications
• Fluoroscopically guided: Balloon-tipped Foley or Fogarty catheter; Dormia-type wire basket
image
(Left) Barium esophagram shows complete obstruction of the esophageal lumen and a filling defect image representing an incompletely chewed piece of meat. Following removal, a Schatzki ring was found.

image
(Right) This 1-year-old child swallowed a watch battery image, which is lodged in the cervical esophagus. Note the smooth outer contour that distinguishes it from the serrated surface of a coin. The coin was removed, but resulted in a persistent stricture of the esophagus.
image
(Left) Esophagram demonstrates the outline of a plastic comb impacted in the distal esophagus and extending into the stomach. On first impression, this might be misinterpreted as an esophageal stent that had been placed across an obstructing esophageal lesion.

image
(Right) Oblique esophagram following endoscopic removal of a foreign body shows extravasation of contrast medium image and free air within the abdomen image. Surgical repair was required.

TERMINOLOGY

Abbreviations

• Esophageal foreign body (FB)

Definitions

• Ingested FB impacted within esophagus

IMAGING

General Features

• Best diagnostic clue

image History of ingestion followed by dysphagia or odynophagia
• Location

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