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  • Title: Value of helical computed tomography in the management of upper esophageal foreign bodies.
    Author: Marco De Lucas E, Sádaba P, Lastra García-Barón P, Ruiz-Delgado ML, González Sánchez F, Ortiz A, Pagola MA.
    Journal: Acta Radiol; 2004 Jul; 45(4):369-74. PubMed ID: 15323387.
    Abstract:
    PURPOSE: To analyze the utility of helical computed tomography (CT) in the diagnosis of suspected upper esophageal foreign bodies. MATERIAL AND 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. CONCLUSION: 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.
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