Jee Hyun Ma MD, Presenter: Nothing to Disclose

Joo Sung Sun MD, MS, Abstract Co-Author: Nothing to Disclose

Kyung Joo Park MD, Abstract Co-Author: Nothing to Disclose

Eun Ho Jang, Abstract Co-Author: Nothing to Disclose

To evaluate the usefulness of MDCT in the diagnosis and management of esophageal foreign bodies according to esophageal level.  

A retrospective study was performed on 28 patients (13 F, 18 M, mean age 49 years) with a history of foreign body impaction. All had negative findings at indirect laryngoscopy. Experienced radiologist and resident independently reviewed 3-mm thick transverse with or without 3 mm-thick coronal CT images and plain radiographs of neck and chest without knowing results. Esophageal level was divided into cervical and thoracic esophagus. The Inter-observer, inter-modality comparisons of sensitivity were performed using McNemar test, and weighted k statics were obtained to evaluate reader agreement in identifying esophageal foreign body according to the level of esophagus.

Twenty three esophageal foreign bodies were identified with 21 esophagoscopies or esophagogastroscopies, and 2 operations. Among 5 patients in whom no foreign body was detected, one patient showed only pneumomediastinum without associate abnormality. In 23 cases of foreign body, 12 (52.2%) esophageal foreign bodies were noted in cervical esophagus and 11 (47.8%) foreign bodies were identified in thoracic esophagus. MDCT revealed 4 additional findings (17.4%, 4/23) as follows: 3 esophageal perforations and 1 pneumomediastinum. The overall sensitivity of MDCT and plain radiographs to detect esophageal foreign body was 95.7% and 86.9% in observer 1, 86.9% and 43.5% in observer 2, respectively. The sensitivities of two modalities were not significantly different between two observers. MDCT showed superior sensitivity than plain radiographs in two observers. There was no significant inter-modality difference in cases of cervical esophagus. However, in cases of thoracic esophagus, MDCT was superior to plain radiographs to detect esophageal foreign body. There was a good inter-observer agreement in 2 modalities. (Table 1, 2) 

MDCT is easy, fast, has high sensitivity and almost perfect inter-observer agreement. Therefore, MDCT should be the first choice technique for diagnosing esophageal foreign bodies not expected to be visible on plain radiographs, particularly thoracic esophagus.

MDCT could demonstrate well esophageal foreign body and give additional information. Hence, MDCT should be first choice modality for diagnosing esophageal foreign body regardless of esophageal level.

Ma, J, Sun, J, Park, K, Jang, E, Value of MDCT in the Diagnosis and Management of Esophageal Foreign Bodies.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8012995.html