Value of MDCT in diagnosis and management of esophageal sharp or pointed foreign bodies according to level of esophagus.

OBJECTIVE: The purpose of this study was to validate the usefulness of MDCT for diagnosis of a sharp or pointed esophageal foreign body according to esophageal level.

MATERIALS AND METHODS: Forty-two patients with a history of sharp or pointed foreign body ingestion were reviewed retrospectively. Two observers interpreted the CT and the conventional radiography datasets separately. If a foreign body was directly identified, it was regarded as a positive finding. Even if no high-density foreign body was found, detection of a secondary finding was considered to be a positive finding. Diagnostic performance of MDCT and conventional radiography were compared according to esophageal level. Final diagnosis was made by esophagoscopy or surgery in addition to the clinicoradiologic result.

RESULTS: MDCT was statistically superior to conventional radiography for diagnosis of a thoracic esophageal foreign body for both observers (p < 0.001 for each). No significant difference in sensitivity between CT and conventional radiography for diagnosis of cervical esophageal foreign body was noted regardless of observer. Both observers could identify all complicated conditions with MDCT regardless of esophageal level. However, in two of three cases of complicated thoracic esophageal foreign bodies, neither observer could detect foreign bodies on conventional radiography; furthermore, the observers could not identify pneumomediastinum.

CONCLUSION: In cases of sharp or pointed foreign body ingestion, if the result of an initial inspection of oro- and hypopharynx reveals negative findings, the first imaging modality should be MDCT for better diagnosis and management.