Lateral soft tissue neck X-rays: are they useful in management of upper aero-digestive tract foreign bodies?

OBJECTIVES: To assess the value of lateral soft tissue neck X-rays in patients presenting with upper aero-digestive tract foreign bodies.

DESIGN: Retrospective study.

INCLUSION CRITERIA: (1) Patients referred to the ENT team, via either the accident and emergency department or their general practitioner; (2) a history of a non-aspirated, upper airway, aero-digestive tract foreign body; and (3) a lateral soft tissue neck X-ray taken on admission.

RESULTS: A total of 62 patients met the inclusion criteria. Twenty-four patients (38.7 per cent) had positive findings on lateral soft tissue neck X-ray. 'Soft' signs, such as widened pre-vertebral shadow and loss of lordosis, were seen in all 24 patients, and foreign bodies were visualised in six patients. Overall, lateral soft tissue neck X-rays were helpful in the management of 32 patients (51.6 per cent). Rather worryingly, doctors in the accident and emergency and ENT departments missed 79.2 and 66.6 per cent of the positive findings, respectively.

CONCLUSIONS: A lateral soft tissue neck X-ray is a helpful tool in the management of patients presenting with upper aero-digestive tract foreign bodies. Junior doctors need better radiology training.