Bedside sonography for the diagnosis of esophageal food impaction

Am J Emerg Med. 2017 May;35(5):720-724. doi: 10.1016/j.ajem.2017.01.008. Epub 2017 Jan 11.


Background: Esophageal foreign body (EFB) and impaction are common gastrointestinal emergencies. Detection with standard imaging can be challenging. Computed tomography is a commonly used non-invasive imaging modality, but is not 100% sensitive and not always feasible. Sensitivity of plain film x-ray varies widely and the addition of a barium swallow can obscure evaluation by subsequent esophagogastroduodenoscopy (EGD). Use of emergency ultrasound (EUS) for detection of EFB in adults has not been previously studied.

Objective: To evaluate the role of EUS in detection of EFB and to characterize sonographic findings.

Methods: A case control series of five patients with clinical suspicion of EFB underwent EUS, and findings were compared to five healthy controls. Patients were evaluated for persistent air-fluid levels after swallowing, esophageal dilatation, and visualization of EFB.

Results: All patients with suspected EFB had esophageal dilatation (17.5mm vs 9.3mm in healthy controls; p=0.0011) and persistent air-fluid levels after swallowing. EFB was visualized on EUS in 60% of patients. All patients had EFB confirmed on EGD except one, who vomited a significant food bolus during EUS and prior to EGD.

Conclusion: In patients with suspected EFB, point-of-care ultrasound may identify those with impaction. Suggestive findings include cervical esophageal dilatation and persistent intraluminal air-fluid levels after swallowing. EUS is a rapid, convenient test with the potential to expedite definitive management while decreasing cost and radiation exposure in this patient population.

Keywords: Emergency; Esophageal foreign body; Esophageal ultrasound; Impaction.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Critical Illness
  • Deglutition Disorders / diagnostic imaging*
  • Deglutition Disorders / etiology
  • Deglutition Disorders / therapy
  • Esophagoscopy
  • Esophagus / diagnostic imaging*
  • Esophagus / physiopathology
  • Feasibility Studies
  • Female
  • Foreign Bodies / complications
  • Foreign Bodies / diagnostic imaging*
  • Foreign Bodies / therapy
  • Humans
  • Male
  • Middle Aged
  • Point-of-Care Testing*
  • Ultrasonography*
  • United States