Diagnostic Performance of Conventional X-ray for Detecting Foreign Bodies in the Upper Digestive Tract: A Systematic Review and Diagnostic Meta-Analysis

Examining the Utility of Lateral Neck X-Rays in Pediatric Otolaryngology

OBJECTIVE

The utility of lateral neck X-rays is unclear in pediatric otolaryngology. Past research showed that lateral neck X-ray did not change treatment decisions for children with suspected foreign body aspiration. This study examines the utility of lateral neck X-ray for patients also receiving otolaryngology consults for any indication.

METHODS

This is a retrospective chart review of pediatric patients between 2012 and 2022 who received a lateral neck X-ray for any indication and an otolaryngology consultation at a tertiary pediatric hospital. X-ray indication, diagnosis, and influence on interventional decisions were recorded from chart review.

RESULTS

Of patients who received lateral neck X-rays, 494 patients (8.17%) also had an otolaryngology consult. Average patient age was 3.15 years. The most common indications for X-ray were foreign body aspiration (22%), croup (21%), breathing difficulties (20%), abscess or retropharyngeal infection (7%), and upper airway obstruction (5%). Lateral neck X-ray changed the Otolaryngologist's decision in 15% of patients. Intervention occurred in 25% of Otolaryngology consults, and this decision was never based on the X-ray.

CONCLUSION

Lateral neck X-ray is unlikely to change Otolaryngology management. It is least indicated in patients presenting with concern of abscess and foreign body aspiration. Consultation with Otolaryngology before ordering diagnostic testing for those presenting with breathing difficulties, croup and upper airway obstruction may have cost savings and prevent unnecessary radiation exposure.

Where Did the Lox 10 Tip Go? A Silent Iatrogenic Foreign Body: Case Report

Esophageal foreign bodies (FBs) are a common medical emergency, often requiring prompt diagnosis and intervention to prevent severe complications. While sharp objects like bones are frequently encountered, iatrogenic foreign bodies remain rare. We present a unique case of an elderly patient who inadvertently swallowed the dislodged tip of a Lignocaine spray applicator during an ENT procedure. Despite being asymptomatic, imaging confirmed the foreign body in the lower esophagus, which was successfully retrieved via flexible endoscopy. Our case highlights the importance of thorough assessment and imaging when foreign body ingestion is suspected, even in asymptomatic individuals. It also highlights the importance of careful equipment inspection, early recognition of potential device malfunctions, and timely intervention to ensure patient safety.

Ensuring that ingested fishbones that migrate to the neck are located, diagnosed, and removed early

OBJECTIVES

The aim of this retrospective study was to explore the clinical characteristics of and diagnostic and therapeutic strategies for the removal of fish bones that migrate to the neck.

METHODS

We reviewed the clinical data of 30 patients over the past 12 years who underwent neck surgery in our otorhinolaryngology department for the migration of fish bones from the throat. The location of fish bones and the positivity rate of different examination methods (neck CT and B-ultrasound) were evaluated statistically. The diagnosis and treatment strategy for fish bone migration to the neck was also summarized.

RESULTS

A total of 24 patients had a history of foreign body ingestion. The duration from foreign body ingestion to the appearance of symptoms in the neck ranged from 26 to 151 days, with a median of 50 days (interquartile range, 32-86 days). Among the 24 patients with fish bones located in the front or side of the neck, 50% (12/24) and 100% (24/24) of whom had positive neck CT and B-ultrasound results, respectively. Additionally, for 6 patients with fish bones in the retropharyngeal space, the positive rate for neck CT was 100%, whereas neck B-ultrasound showed negative results due to the air and depth in the trachea and esophagus. A strong correlation was observed between the length of fish bones detected by B-ultrasound and CT and the actual length. Indeed, no significant difference was observed between the length of fish bone determined by B-ultrasound and the actual length. In patients with fish bones located in the anterior and lateral neck regions, the foreign bodies were successfully removed by a lateral cervical approach operation (23/24). For the 6 cases with fish bones located in the retropharyngeal space, all (6/6) were removed by incising the posterior pharyngeal wall with assistance from transoral endoscopy.

CONCLUSIONS

The techniques of B-ultrasound and CT have advantages for the diagnosis of migratory foreign bodies in the neck. Although B-ultrasound is more accurate for estimating the length of migratory fish bones in the neck, a combination of both methods can improve the preoperative positive rate of diagnosis. Therefore, a variety of surgical approaches should be employed to manage the different locations of cervical foreign bodies.