- Email: [email protected]
Esophageal emergency, no more
Visual Journal of Emergency Medicine 9 (2017) 67–68
Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
Esophageal emergency, no more
MARK
⁎
Jean Dorce, Jimmy Truong , Hui Huang, Andrew Rende Department of Emergency Medicine, St Barnabas Health System, 4422 3rd Ave, Bronx, NY 10457, USA
A R T I C L E I N F O Keywords: Foreign body Esophageal emergency
A 59 year old male presented to the Emergency Department after eating lamb for lunch where he accidentally swallowed a piece of bone. After unsuccessful attempts to expel the foreign body by coughing at home, he arrived with stable vital signs and continued discomfort in his
neck. The patient did not have any airway compromise and was speaking in complete sentences with no drooling or trismus. Physical exam revealed no visible foreign body in the oropharynx. The patient had a CT of the soft tissue neck shown in Figs. 1 and 2 showing a linear
Fig. 1. Coronal view of the CT of the soft tissue neck with linear foreign body in the posterior hypopharynx at the level of the false cords (red arrow).
Fig. 2. Coronal view of the CT of the soft tissue neck with linear foreign body in the posterior hypopharynx at the level of the false cords extended laterally (red arrow).
⁎
Corresponding author. E-mail address: [email protected] (J. Truong).
http://dx.doi.org/10.1016/j.visj.2017.07.017 Received 4 May 2017; Received in revised form 4 July 2017; Accepted 17 July 2017 2405-4690/ © 2017 Elsevier Inc. All rights reserved.
Visual Journal of Emergency Medicine 9 (2017) 67–68
J. Dorce et al.
Questions 1. Which of the following is easily detectable on plain radiographs? a. Plant thorns b. Cactus spines c. Metals d. Plastics e. Wood 2. Which of the following is NOT considered an emergency for urgent endoscopy? a. Ingestion of a toothpick b. Ingestion of button batteries c. Evidence of perforation d. Marble in the rectum e. Ingestion of aluminum soda can tabs Answers
1. Metals. Explanation: Material such as wood, thorns, fish bones, organic matter, and most plastics are not visible on plain films. High resolution ultrasonography can detect wood, metal, glass, plant thorns, cactus spines, and plastics with moderate to good sensitivity. CT is good at detecting wood, plant thorns, cactus spines, and plastics and excellent at detecting metal and glass. Foreign bodies made of wood may mimic air bubbles on CT. A contraindication to MR Imaging is the presence of metal foreign bodies or devices, making it a poor choice to detect metal. Reference: 1. Richard L. Soft Tissue Foreign Bodies. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016. 2. Marble in the rectum. Explanation: There are several scenarios that require urgent endoscopy for esophageal foreign bodies. These include ingestion of sharp or elongated objects such as toothpicks, and aluminum soda can tabs, multiple foreign bodies, button batteries, evidence of perforation, airway compromise, presence of a coin at the level of the cricopharyngeus muscle or C6 in a child, or the presence of a foreign body for greater than 24 h. Reference: Mendelson M. Esophageal Emergencies. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016.
Fig. 3. Recovered foreign body after spontaneous expectoration measuring approximately 3.8 cm.
calcified foreign body approximately 3.6 cm in length in the posterior supraglottic airway, proximal to the origin of the esophagus at the level of the false vocal cords consistent with a bone without perforation. ENT was immediately consulted and the patient was consented for direct visualization of the oropharynx with a fiberoptic scope. Suddenly, while still in the ED, with a forceful cough, the patient expelled the foreign body into his hand, shown in Fig. 3. Pathology report identified the foreign body as a toothpick. Appendix A. Supporting information Supplementary data associated with this article can be found in the online version at doi:10.1016/j.visj.2017.07.017.
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Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
Esophageal emergency, no more
MARK
⁎
Jean Dorce, Jimmy Truong , Hui Huang, Andrew Rende Department of Emergency Medicine, St Barnabas Health System, 4422 3rd Ave, Bronx, NY 10457, USA
A R T I C L E I N F O Keywords: Foreign body Esophageal emergency
A 59 year old male presented to the Emergency Department after eating lamb for lunch where he accidentally swallowed a piece of bone. After unsuccessful attempts to expel the foreign body by coughing at home, he arrived with stable vital signs and continued discomfort in his
neck. The patient did not have any airway compromise and was speaking in complete sentences with no drooling or trismus. Physical exam revealed no visible foreign body in the oropharynx. The patient had a CT of the soft tissue neck shown in Figs. 1 and 2 showing a linear
Fig. 1. Coronal view of the CT of the soft tissue neck with linear foreign body in the posterior hypopharynx at the level of the false cords (red arrow).
Fig. 2. Coronal view of the CT of the soft tissue neck with linear foreign body in the posterior hypopharynx at the level of the false cords extended laterally (red arrow).
⁎
Corresponding author. E-mail address: [email protected] (J. Truong).
http://dx.doi.org/10.1016/j.visj.2017.07.017 Received 4 May 2017; Received in revised form 4 July 2017; Accepted 17 July 2017 2405-4690/ © 2017 Elsevier Inc. All rights reserved.
Visual Journal of Emergency Medicine 9 (2017) 67–68
J. Dorce et al.
Questions 1. Which of the following is easily detectable on plain radiographs? a. Plant thorns b. Cactus spines c. Metals d. Plastics e. Wood 2. Which of the following is NOT considered an emergency for urgent endoscopy? a. Ingestion of a toothpick b. Ingestion of button batteries c. Evidence of perforation d. Marble in the rectum e. Ingestion of aluminum soda can tabs Answers
1. Metals. Explanation: Material such as wood, thorns, fish bones, organic matter, and most plastics are not visible on plain films. High resolution ultrasonography can detect wood, metal, glass, plant thorns, cactus spines, and plastics with moderate to good sensitivity. CT is good at detecting wood, plant thorns, cactus spines, and plastics and excellent at detecting metal and glass. Foreign bodies made of wood may mimic air bubbles on CT. A contraindication to MR Imaging is the presence of metal foreign bodies or devices, making it a poor choice to detect metal. Reference: 1. Richard L. Soft Tissue Foreign Bodies. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016. 2. Marble in the rectum. Explanation: There are several scenarios that require urgent endoscopy for esophageal foreign bodies. These include ingestion of sharp or elongated objects such as toothpicks, and aluminum soda can tabs, multiple foreign bodies, button batteries, evidence of perforation, airway compromise, presence of a coin at the level of the cricopharyngeus muscle or C6 in a child, or the presence of a foreign body for greater than 24 h. Reference: Mendelson M. Esophageal Emergencies. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016.
Fig. 3. Recovered foreign body after spontaneous expectoration measuring approximately 3.8 cm.
calcified foreign body approximately 3.6 cm in length in the posterior supraglottic airway, proximal to the origin of the esophagus at the level of the false vocal cords consistent with a bone without perforation. ENT was immediately consulted and the patient was consented for direct visualization of the oropharynx with a fiberoptic scope. Suddenly, while still in the ED, with a forceful cough, the patient expelled the foreign body into his hand, shown in Fig. 3. Pathology report identified the foreign body as a toothpick. Appendix A. Supporting information Supplementary data associated with this article can be found in the online version at doi:10.1016/j.visj.2017.07.017.
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