The Utility of Diagnostic Imaging in Fish Bone Impaction

Abstract

Objectives: The purpose of this pilot study was to obtain an Australian perspective on evaluating the utility of plain film radiography and computed tomography (CT) to rule out fish bone impaction in the upper aerodigestive tract in the emergency department (ED) setting. Methods: A retrospective multicentre cohort study was conducted. A total of 73 patients met the inclusion criteria. A subgroup of patients underwent CT. We studied the sensitivity and specificity of x-ray and CT along with other demographic variables to determine the likelihood of true fish bone impaction. Results: Out of the 73 patients, 28 patients had true bone impaction. The sensitivity for x-ray was 42.9% and specificity was 73.3%. The sensitivity of CT was 87.5% and specificity was 71.4%. We found a significant difference in the mean age of presentation for true bone and false bone impaction, P = 0.02. Conclusion: Due to the low sensitivity of x-ray we do not recommend the utilisation of plain film radiography to rule out bone impaction Advances in low dose radiation multidetector CT scanners may replace plain film radiography as a screening tool.

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

“…Of these 61 studies, 44 were excluded (12 were case reports or series and letters, 1 was a cadaver study, 1 was a review, 6 excluded the target population, 6 did not include the index test of interest, and 7 did not examine the outcome of interest). Finally, 17 studies that met the inclusion criteria were included [ 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

“…Among 17 studies, 14 [ 4 , 7 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 21 , 22 ] were performed in Asia, 2 [ 8 , 20 ] in Europe, and 1 [ 10 ] in Australia. A total of 5 studies [ 4 , 16 , 19 , 20 , 21 ] were prospective, 11 [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 17 , 18 , 22 ] were retrospective, and 1 [ 7 ] was a case–control study. Regarding the study setting, six studies recruited patients only from the ED, three recruited only hospitalized patients, three included patients from the ED or outpatient department or hospitalized patients, and five did not provide clear information.…”

“…Regarding the study setting, six studies recruited patients only from the ED, three recruited only hospitalized patients, three included patients from the ED or outpatient department or hospitalized patients, and five did not provide clear information. Regarding inclusion criteria, seven studies [ 4 , 8 , 10 , 13 , 17 , 21 , 22 ] focused on the ingestion of fish bones and seven [ 7 , 9 , 12 , 15 , 16 , 17 , 21 ] focused on esophageal FBs. The sample sizes of studies ranged from 45 to 1338.…”

“…The conventional X-ray is usually used as the first-line imaging modality to detect FBs. Although several studies [ 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] have investigated the use of conventional X-rays for detecting FBs, they have reported inconsistent results in terms of diagnostic performance, with sensitivity ranging from 15% to more than 90% [ 7 , 19 ] and specificity ranging from 50% to 100% [ 7 , 8 ]. The American Society for Gastrointestinal Endoscopy and the European Society for Gastrointestinal Endoscopy (ESGE) guidelines strongly recommend using conventional X-rays to detect the presence, location, size, configuration, and the number of ingested FBs if the ingestion of radiopaque objects is suspected or if the type of object is unknown.…”

Role of Conventional Plain X- Rays in Upper Aerodigestive Tract Fish Bone Impaction

“…In case of impaction, the patient usually experiences sharp pain after taking the 4 bolus and develops odynophagia. The commonest sites of impaction in descending frequency are tonsil, tongue base, pyriform sinus and vallecullae, however, rarely it can get impacted in 4,5 esophagus. If an impacted fish bone is not removed it can result in serious complications like mediastinitis, retro and parapharyngeal abcesses and rarely oesophago-aortic fistula, all of which 5 can have fatal eventuality.…”