Learning Radiology xray montage
 
 
 
 
 

Impacted Chicken Bone in Esophagus




 
  • Soft tissue measurements on the lateral neck image
    • At C3: <3 mm (less than 1/3 AP diameter)
    • At C6: < the AP width of C6 vertebral body

  • Impacted esophageal foreign bodies 

            
    • Food or true foreign bodies
      • Chicken bones (opaque), fish bones (non-opaque)
      • Coins, toy trucks
    • Most often they impact just below cricopharyngeous (70%)
      • Another 20% impact at the level of the aortic arch
      • Another 10% at EG junction
      • Once past the esophagus, most foreign bodies will pass through the GI tract

  • Clinical findings of an impacted esophageal foreign body

    • Dysphagia and odynophagia most commonly
    • Even if FB passes, many complain of pain referable to cervical esophagus

  • Imaging Findings

    • Always check for lead lines in children
      • Pica
    • Chicken bones are usually opaque
      • Fish bones contain less calcium and usually are not
    • Plain films usually do not demonstrate the FB but are still obtained first
      • If negative, then either contrast esophagram or CT if high index of suspicion

  • Treatment

    • Removal is most often performed using endoscopy
    • Temporization and surgery are other options
    • An ingested button battery lodged in esophagus must be removed immediately

  • Complications of an impacted foreign body

    • Perforation
      • Longer the FB remains impacted (>24hrs), higher incidence of perforation
    • Stricture
    • Diverticulum formation

 
Impacted Foreign Body. Lateral radiograph of the neck demonstrates a linear density in the region of the proximal esophagus (red arrow) consistent with an impacted foreign body--in this case, a chicken bone. There is no air in the soft tissues and no soft tissue swelling is identified to indicate the presence of a retropharyngeal abscess.