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Imaging approach to ingested foreign bodies in the neck

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Abstract

Foreign body ingestion is a common clinical occurrence worldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck.

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Funding

The elaboration of this manuscript was not funded.

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Authors and Affiliations

  1. Department of Radiology, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, MA, USA

    Serena T. Pham & V. Carlota Andreu-Arasa

  2. Division of Neuroradiology, Department of Radiology, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA

    Osamu Sakai

  3. Division of Neuroradiology, Department of Radiology, VA Boston Healthcare System, Boston, MA, USA

    V. Carlota Andreu-Arasa

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  1. Serena T. Pham
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  3. V. Carlota Andreu-Arasa
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Correspondence to V. Carlota Andreu-Arasa.

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Key points

• Neck radiography, with at least frontal and lateral views, is the initial imaging modality to evaluate the characteristics of radiopaque ingested foreign bodies, the impaction site, and the presence of complications.

• Neck computerized tomography has 100% sensitivity and 94–97% specificity in confirming the characteristics and impaction sites of radiolucent foreign bodies that are otherwise not visible on radiographs. It is also helpful in assessing the integrity of the adjacent anatomic structures and associated complications.

• Neck and cervical spine magnetic resonance imaging have no role in the initial evaluation of foreign body ingestion and are mainly used to assess the extent of deep neck infection.

• Fluoroscopic barium swallow and esophagram are not recommended for the initial evaluation due to the increased risk of aspiration and the potential obscuring visualization during subsequent endoscopy with oral contrast. However, fluoroscopic esophagram with water-soluble contrast can be an alternative post-intervention imaging modality in assessing esophageal mucosal integrity.

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Pham, S.T., Sakai, O. & Andreu-Arasa, V.C. Imaging approach to ingested foreign bodies in the neck. Neuroradiology (2024). https://doi.org/10.1007/s00234-024-03348-5

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