Role of Plain Xray Soft Tissue Neck Lateral View in the diagnosis of Cervical Esophageal Foreign Bodies

Something's “Fishy” With That Sore Throat...

“…Plain radiographs of the neck and chest will commonly show the location of radiopaque objects, such as coins (Pinto et al, 2012). Plain radiographs are routinely used in the diagnosis of upper airway foreign bodies, although their usefulness can be debatable (Rishi, Rais, & Baskota, 2008). The lateral view has gained more importance than the AP view as this view can differentiate foreign bodies in the esophagus from the tracheobronchial region.…”

“…The lateral view has gained more importance than the AP view as this view can differentiate foreign bodies in the esophagus from the tracheobronchial region. Patient management also differs depending on the location of the foreign body in the different parts of esophagus (Rishi et al, 2008). Knowledge of normal radiographic anatomy is essential in assessing radiographs of the soft tissue of the neck.…”

“…It is a noninvasive, highly specific study that is both inexpensive and easily tolerated by patients. In addition, it can be completed without departmental delay (Rishi et al, 2008). However, normal soft tissue of the neck does not exclude a foreign body.…”

“…Fishbone foreign bodies are often radiopaque and can be visualized on a radiograph. However, when these are not visualized on a radiograph, soft signs increase diagnostic identification of foreign bodies on a lateral soft-tissue neck radiograph (Rishi et al, 2008). Soft signs are identified as the presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, or increased prevertebral soft-tissue thickening (Rishi et al, 2008).…”

“…However, when these are not visualized on a radiograph, soft signs increase diagnostic identification of foreign bodies on a lateral soft-tissue neck radiograph (Rishi et al, 2008). Soft signs are identified as the presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, or increased prevertebral soft-tissue thickening (Rishi et al, 2008). The combined soft signs of the presence of radiographic density and air column lucency provides the highest accuracy (98.6%) for possible foreign body identification (see Table 1).…”