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Am J Emerg Med. 2017 May;35(5):720-724. doi: 10.1016/j.ajem.2017.01.008. Epub 2017 Jan 11.

Bedside sonography for the diagnosis of esophageal food impaction.

Author information

1
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, United States. Electronic address: jmsingle@bidmc.harvard.edu.
2
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, United States. Electronic address: jmschafe@bidmc.harvard.edu.
3
Department of Emergency Medicine, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Baltimore, MD 21287, United States. Electronic address: jeremiah.s.hinson@gmail.com.
4
Department of Emergency Medicine, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Baltimore, MD 21287, United States. Electronic address: ekane9@jhmi.edu.
5
Department of Emergency Medicine, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Baltimore, MD 21287, United States. Electronic address: sheriekawright895@hotmail.com.
6
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, United States. Electronic address: bhoffma2@bidmc.harvard.edu.

Abstract

BACKGROUND:

Esophageal foreign body (EFB) and impaction are common gastrointestinal emergencies. Detection with standard imaging can be challenging. Computed tomography is a commonly used non-invasive imaging modality, but is not 100% sensitive and not always feasible. Sensitivity of plain film x-ray varies widely and the addition of a barium swallow can obscure evaluation by subsequent esophagogastroduodenoscopy (EGD). Use of emergency ultrasound (EUS) for detection of EFB in adults has not been previously studied.

OBJECTIVE:

To evaluate the role of EUS in detection of EFB and to characterize sonographic findings.

METHODS:

A case control series of five patients with clinical suspicion of EFB underwent EUS, and findings were compared to five healthy controls. Patients were evaluated for persistent air-fluid levels after swallowing, esophageal dilatation, and visualization of EFB.

RESULTS:

All patients with suspected EFB had esophageal dilatation (17.5mm vs 9.3mm in healthy controls; p=0.0011) and persistent air-fluid levels after swallowing. EFB was visualized on EUS in 60% of patients. All patients had EFB confirmed on EGD except one, who vomited a significant food bolus during EUS and prior to EGD.

CONCLUSION:

In patients with suspected EFB, point-of-care ultrasound may identify those with impaction. Suggestive findings include cervical esophageal dilatation and persistent intraluminal air-fluid levels after swallowing. EUS is a rapid, convenient test with the potential to expedite definitive management while decreasing cost and radiation exposure in this patient population.

KEYWORDS:

Emergency; Esophageal foreign body; Esophageal ultrasound; Impaction

PMID:
28119013
DOI:
10.1016/j.ajem.2017.01.008
[Indexed for MEDLINE]

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