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Weekly Chest CasesArchive of Old Cases

Case No : 640 Date 2010-02-01

  • Courtesy of Jeong Joo Woo / Eulji Hospital, School of medicine, Eulji university
  • Age/Sex 47 / F
  • Chief ComplaintPostprandial substernal pain for 4 days
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Fish bone impaction in the esophagus(with perforation, esophagitis )
Radiologic Findings
Nonenhanced CT images at the lower third level of the esophagus show a linear radiopaque density in the esophagus with a diffusely thickened wall and several tiny foci of extraluminal gas that are suggestive of a perforation caused by foreign body impaction. Contrast-enhanced CT images show enhancement in the thickened esophageal wall. Left pleural effusion is associated.
Fish bone impaction on the esophageal wall causing mucosal perforation with esophagitis was revealed and removal of the bone with clipping of the perforation site was done through endoscopy.
Brief Review
Most ingested objects pass spontaneously, without intervention. However, the thin esophageal wall, the lack of a supporting adventitia, and the relatively poor blood supply leave the esophagus vulnerable to perforation and pressure necrosis from foreign bodies that become lodged in it. Between 10% and 20% of ingested foreign bodies, including those retained within the esophagus, therefore require endoscopic
removal, and surgery is needed in about 1% of cases .
The clinical manifestations of esophageal foreign body impaction are variable: Symptoms may include dysphagia, odynophagia, foreign body sensation, and food refusal. Regurgitation and an inability to swallow saliva are suggestive of esophageal obstruction. When a history of foreign body ingestion is elicited, a radiographic
evaluation is performed, generally with conventional radiography of the neck, chest, and
abdomen . Barium studies are discouraged because they may hinder subsequent attempts at endoscopic examination and retrieval.
CT may be useful in select cases when a more definitive diagnosis or localization is desired before endoscopic intervention, or when perforation or another complication is suspected. In patients who do not provide a history of foreign body ingestion and who report nonspecific symptoms such as chest pain, CT often is used to distinguish
between or exclude potential causes during the initial evaluation.
The CT appearance of foreign body impaction is variable, depending on the item ingested, the site of impaction, and the presence of an underlying pathologic esophageal process or associated complication.
References
1. Young CA, Menias CO, Bhalla S, Prasad SR. CT features of esophageal emergencies. Radiographics 2008;28:1541-1553
2. Fadoo F et al. Helical CT esophagography for the evaluation of suspected esophageal perforation or rupture. AJR 2004;182:1177-1179
Keywords
Esophagus, Non-infectious inflammation,

No. of Applicants : 102

▶ Correct Answer : 72/102,  70.6%
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - SMG-SNUH boramae medical center , Korea (South) Kwang Nam Jin
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Osaka University , Japan Osamu Honda
  • - University of British Columbia , Canada Amr Ajlan
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OKUBO
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - radiologist, aditya imaging centre , India vivek patel
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - NTUH , Taiwan Kuei-pin Chung
  • - hospital , Saudi Arabia marwan alchami
  • - Yashoda Superspeciality hospital , India Pravin Mahadevappa
  • - CHRU lille , France manuel toledano
  • - Teleradiology solutions , India harish bhambore
  • - Samsung Medical Center , Korea (South) Sang Yu Nam
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - DRPGMC TANDA , India maneesh verma
  • - Institute of Chest Diseases,Calicut , India sijith raghavan
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - DRRPGMC KANGRA AT TANDA , India dinesh sood
  • - McGill University , Canada Ben Smith
  • - Paramount Diagnostic & Research Centre , India Mahavir Swami
  • - Gangnam Severance Hospital , Korea (South) Min Jeong Kim
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Retd. Prof Thoracic Surgery B.J.MEDIDCAL COLLEGE Punr India , India Bankim Amin
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Hospital M�e de Deus , Brazil Thiago Bento da Silva
  • - Samsung Medical Center , Korea (South) Ju Won Lee
  • - CH Sud R�union , Reunion jean-baptiste Noel
  • - kyungpook national university hospital , Korea (South) jiwon park
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - care hospital , India Chary D
  • - Cairo University , Egypt Mamdouh Eissa
  • - KMC,Manipal , India satish maddukuri
  • - Service de pneumologie, H�pitaux Universitaires de Gen�ve , Switzerland GREGOIRE GEX
  • - medi max health imaging center , India nitin patel
  • - , Korea (South) Woojeong Kim
  • - Lilavati Hospital , India Pralhad Prabhudesai
  • - McGill University Health Center , Canada Alexandre Semionov
  • - S V S MEDICAL COLLEGE , India SUNIL ALMALE
  • - Russia , Saudi Arabia jehad alakabani
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Apollo Gleneagles hosp kolkata , India SALIM PARVEZ
  • - Chungnam national university hospital , Korea (South) Jeoung Eun Lee
  • - Saga University , Japan Ryoko Egashira
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - Kyungpook National Univ. Hospital , Korea (South) Sang-yub Lee
  • - Armed Force Capital Hospital , Korea (South) Dae Kun Oh
  • - Thomas Jefferson University Hospital , United States Dinesh Sharma
  • - IRSA rochefort , France Viviane Pages
  • - Montreal Chest Institute , Canada Faiz Khan
  • - Dong-A university hospital , Korea (South) Sang-yun LEE
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - National Taiwan University Hospital, YL branch , Taiwan Chin-Chung Shu
  • - Doctors Hospital , Bahamas muneesh sharma
  • - Pneumology GHSR , Reunion fabrice paganin
  • - CHRU Lille , France guillaume lefebvre
  • - Yonsei university Shinchon Severance hospital , Korea (South) Na-young Shin
  • - NASA SCANS , India RAKESH BHATIA
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - CHU Grenoble , France Fabrice Bing
  • - Sacr�-Coeur , Canada Andrea Ojanguren
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - GMCH chandigarh , India sonali jain
  • - Assam Medical College , India Karunakaran M
▶ Correct Answer as Differential Diagnosis : 7/102,  6.9%
  • - SMC , Korea (South) Jihoon Cha
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - ROK air force aerospacemedical center , Korea (South) Daekeon Lim
  • - SoonChunHyang univ. hospital , Korea (South) Kim Jae Hyun
  • - Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
  • - All India Institute of medical sciences , India Justin Moses
▶ Semi-Correct Answer : 6/102,  5.9%
  • - Goa Medical College , India Paresh Desai
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - kovai medical centre , India k bhaskar
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