The lateral neck radiograph for an impacted fish bone in the aero-digestive tract: Going back to basics

Dushyant Shetty,David At Gay

doi:10.4236/jbise.2012.512a104

Abstract

Aim: To evaluate the radioopacity of fish bones from a number of species using digital radiography in order to establish whether advances in acquisition and interpretative techniques have affected the radiologist’s ability to detect impacted fish bones. Methods: The bones from six species of fish commonly consumed in the United Kingdom were radiographed using a soft tissue neck phantom by means of a digital radiographic X-ray tube. The images were looked at by 15 radiology consultants and registrars who determined whether the bones were visible or not using General Electric (GE) PACS workstations. Results: The radio-graphed bones from all six species of fish were visible by all 15 (100%) radiology registrars and consultants. Conclusion: Digital radiogramphy and modern PACS workstations have meant that fish bones can be visualized irrespective of species. The lateral neck radiograph therefore may still have an important role in the investigation of impacted fish bones in the aerodigestive tract.

Highlights

Ingestion and impaction of a foreign body (FB) is a common reason for an acute presentation to hospital [1]
There is ongoing debate as to the potential role of plain film radiography in the initial assessment of patients presenting with an impacted foreign body
As stated by Palme et al [1], the authors are in total agreement that computed tomography (CT) is far superior to plain film radiography in both the detection and accurate localization of a fish bone as well as the recognition of any complications

Summary

Introduction

Ingestion and impaction of a foreign body (FB) is a common reason for an acute presentation to hospital [1]. Whilst children account for up to 80% of foreign body ingestion or impaction [2], the most commonly ingested foreign bodies in adults are fish bones [3]. Most impacted fish bones can be readily identified and retrieved under direct vision, a number of patients require radiological investigation for localization. A lateral soft tissue neck radiograph remains the first line investigation to aid localization

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Conclusion