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The utility of lateral neck radiographs in the management of fish bones

  • T Pitts-Tucker (a1), T C Biggs (a2) and N N Patel (a2)

Abstract

Background

Lateral neck radiographs are commonly used in the investigation and management of patients presenting with suspected fish bone impaction. The effectiveness of these is questioned, as many fish do not have radio-opaque bones.

Objective

This study evaluated the utility of lateral neck radiographs in the management of patients presenting with fish bones retained in the upper aerodigestive tract, with the creation of a treatment algorithm to guide further management.

Methods

An audit of practice was undertaken at the University Hospital of Southampton, identifying all patients admitted with potential fish bone impaction in the upper aerodigestive tract. Following analysis, a treatment algorithm was constructed for use by junior doctors.

Results

In total, 34 per cent of patients with a normal radiograph were subsequently found to have a fish bone present under local or general anaesthetic assessment. The sensitivity of radiographs in the detection of fish bones was found to be 51.6 per cent.

Conclusion

Lateral neck radiographs have limited value in the management of suspected fish bone impaction, and should only be used following detailed clinical examination of the upper aerodigestive tract.

Copyright

Corresponding author

Author for correspondence: Mr Toby Pitts-Tucker, Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, SouthamptonSO16 6YD, UK E-mail: tobypittstucker@gmail.com

Footnotes

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Mr T Pitts-Tucker takes responsibility for the integrity of the content of the paper

Footnotes

References

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1Venkatesh, SH, Venkatanarasimha Karaddi, NK. CT findings of accidental fish bone ingestion and its complications. Diagn Interv Radiol 2016;22:156–60
2Ell, SR, Parker, AJ. The radio-opacity of fishbones. Clin Otolaryngol Allied Sci 1992;17:514–16
3Ballivet-de-Regloix, S, Crambert, A, Maurin, O, Bonfort, G, Marty, S, Pons, Y. Fishbones in the upper aerodigestive tract: a review of 24 cases of adult patients. Iran J Otorhinolaryngol 2017;29:215–19
4Sundgren, PC, Burnett, A, Maly, PV. Value of radiography in the management of possible fishbone ingestion. Ann Otol Rhinol Laryngol 1994;103:628–31
5Wu, IS, Ho, TL, Chang, CC, Lee, HS, Chen, MK. Value of lateral neck radiography for ingested foreign bodies using the likelihood ratio. J Otolaryngol Head Neck Surg 2008;37:292–6
6Jahshan, F, Sela, E, Layous, E, Levy, E, Assadi, N, Shilo, E et al. Clinical criteria for CT scan evaluation of upper digestive tract fishbone. Laryngoscope 2018;128:2467–72
7Akazawa, Y, Watanabe, S, Nobukiyo, S, Iwatake, H, Seki, Y, Umehara, T et al. The management of possible fishbone ingestion. Auris Nasus Larynx 2004;31:413–16
8Kamath, P, Bhojwani, KM, Prasannaraj, T, Abhijith, K. Foreign bodies in the aerodigestive tract--a clinical study of cases in the coastal belt of South India. Am J Otolaryngol 2006;27:373–7

Keywords

The utility of lateral neck radiographs in the management of fish bones

  • T Pitts-Tucker (a1), T C Biggs (a2) and N N Patel (a2)

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