79 year-old woman complained about dysphagia

 

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Doctor's Information

Name : Maryam
Family :Noori
Affiliation : Teb Azma Imaging Center,Ghom,Iran
Academic Degree: Radiologist
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : ----------------

 

Patient's Information

Gender : Female
Age : 79

 

Case Section

Head & Neck Imaging

 

Clinical Summary

79 year old woman complained about dysphagia.

 

 

Imaging Procedures and Findings

A 79 year old woman complained about dysphagia & a sensation of a foreign body in the throat from one week ago. She underwent spiral CT scan with no contrast. On obtained axial images, a dense ossified foreign lesion is depicted near the region of the cricopharyngeus. On coronal & sagittal images the lesion is better confirmed.

 

Discussion

Animal or fish bones tend to lodge in the pharynx, often near the level of the cricopharyngeus. The patient may complain of pharyngeal dysphagia or of a sensation of a foreign body in the throat. In contrast, meat bolus impactions tend to occur in the distal esophagus and are manifested by the sudden onset of substernal chest pain, odynophagia, or dysphagia. Some patients with distal foreign body impactions may have dysphagia that is referred to the pharynx, however, so that the subjective site of obstruction is unreliable in determining the level of impaction. Esophageal perforation occurs in less than 1% of all patients with foreign body impactions. However, the risk of perforation increases substantially if the impaction persists more than 24 hours. AP and lateral radiographs of the neck and chest may occasionally demonstrate bones or other radiopaque foreign bodies in the pharynx or esophagus. Lateral radiographs of the neck are usually more helpful than AP because these bones are easily obscured by the overlying cervical spine on AP radiographs. Nevertheless, considerable difficulty may be encountered in differentiating small bone fragments from calcified thyroid or cricoid cartilage. Animal or fish bones in the pharynx or cervical esophagus are easily obscured by barium, so that they may be difficult to detect on contrast examinations. These foreign bodies, however, can sometimes be recognized as linear filling defects in the vallecula, piriform sinus, or cricopharyngeal region. In some cases, cotton balls or marshmallows soaked in barium may also be helpful for demonstrating small foreign bodies in the pharynx or esophagus. Foreign body impactions in the thoracic esophagus usually result from a large bolus of unchewed meat that lodges above the gastroesophageal junction or above a pathologic area of narrowing, most commonly a Schatzki ring or peptic stricture. Although the radiographic appearance could be mistaken for a polypoid carcinoma obstructing the esophagus, the correct diagnosis is almost always apparent from the clinical history.

 

Final Diagnosis

Lodged chicken??s bone near the cricopharyngeous region.

 

References

Textbook of Gasterointestinal Radiology. Gore & Levine. vol 1 Diagnostic Imaging Abdomen. Federle, et al.

 

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