Value of helical computed tomography in the management of upper esophageal foreign bodies.
OBJECTIVE
To analyze the utility of helical computed tomography (CT) in the diagnosis of suspected upper esophageal foreign bodies.


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.


CONCLUSIONS
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.
Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla s/n, Santander 39008, Cantabria, Spain. emarco@seram.org
E
E
Marco De Lucas
P
P
Sádaba
P
P
Lastra García-Barón
M L
ML
Ruiz-Delgado
F
F
González Sánchez
A
A
Ortiz
M A
MA
Pagola
D000368:Aged; D001466:Barium Sulfate; D003287:Contrast Media; D004939:Esophageal Perforation / Q000000981:diagnostic imaging; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging*; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome
D003287:Contrast Media; D001466:Barium Sulfate