Value of helical computed tomography in the management of upper esophageal foreign bodies

Acta Radiol. 2004 Jul;45(4):369-74. doi: 10.1080/02841850410005516.

Abstract

Purpose: To analyze the utility of helical computed tomography (CT) in the diagnosis of suspected upper esophageal foreign bodies.

Material and methods: A prospective study was performed on 36 patients (26 F, 10 M, mean age 70 years) with a history of foreign body impaction. All had negative findings at indirect laryngoscopy. Radiologic assessment included unenhanced helical CT and a barium contrast study. Patients with positive findings were taken to esophagoscopy. All patients had a posterior clinical surveillance.

Results: Twenty patients had both normal CT and barium study and satisfactory clinical outcome. In 12 patients a foreign body was noted in the cervical esophagus by CT, barium study, and endoscopy. In one patient a fish bone was detected by CT (and not by barium) confirmed with esophagoscopy. Another patient had a fish bone esophageal perforation which was observed only by CT and confirmed at surgery. Two patients with normal barium and endoscopy presented a false-positive CT result.

Conclusion: Barium swallow is currently the first radiologic study, but may involve a risk of aspiration and can impede a subsequent esophagoscopy. Esophagoscopy is an invasive technique with a certain risk of serious complications that can be avoided with a satisfactory radiologic assessment. CT is easy, fast, has 100% sensitivity and is therefore the first choice technique for diagnosing suspected upper esophageal foreign bodies not expected to be visible on plain radiographs.

MeSH terms

  • Aged
  • Barium Sulfate
  • Contrast Media
  • Esophageal Perforation / diagnostic imaging
  • Esophagoscopy
  • Esophagus / diagnostic imaging*
  • False Positive Reactions
  • Female
  • Follow-Up Studies
  • Foreign Bodies / diagnostic imaging*
  • Humans
  • Laryngoscopy
  • Male
  • Middle Aged
  • Prospective Studies
  • Sensitivity and Specificity
  • Tomography, Spiral Computed*
  • Treatment Outcome

Substances

  • Contrast Media
  • Barium Sulfate