title: Bedside sonography for the diagnosis of esophageal food impaction.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, United States. Electronic address: jmsingle@bidmc.harvard.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Singleton
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, United States. Electronic address: jmschafe@bidmc.harvard.edu.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Schafer
authors.affiliation: Department of Emergency Medicine, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Baltimore, MD 21287, United States. Electronic address: jeremiah.s.hinson@gmail.com.
authors.forename: Jeremiah S
authors.initials: JS
authors.lastname: Hinson
authors.affiliation: Department of Emergency Medicine, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Baltimore, MD 21287, United States. Electronic address: ekane9@jhmi.edu.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Kane
authors.affiliation: Department of Emergency Medicine, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Baltimore, MD 21287, United States. Electronic address: sheriekawright895@hotmail.com.
authors.forename: Sherieka
authors.initials: S
authors.lastname: Wright
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, United States. Electronic address: bhoffma2@bidmc.harvard.edu.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Hoffmann
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D016638:Critical Illness; D003680:Deglutition Disorders / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing; D014463:Ultrasonography; D014481:United States
keywords: Emergency; Esophageal foreign body; Esophageal ultrasound; Impaction