Castán Senar Alba, Dinu Laura E, Artigas José M, Larrosa Raquel, Navarro Ylenia, Angulo Elena
From the Department of Radiology, Miguel Servet University Hospital, Paseo Isabel la Católica 1-3, 50009 Zaragoza, Spain.
Radiographics. 2017 Jan-Feb;37(1):323-345. doi: 10.1148/rg.2017160073.
Foreign-body (FB) ingestion is less common in adults than in children, but still occurs. Diagnostic management of patients with suspected FB ingestion in emergency departments depends on FB type and location, both of which are related to the patient profile. In adults, fish and chicken bones are the most common FB types, and the oropharynx and cricopharyngeal muscle are the most common locations. Once accidentally swallowed, an FB may become lodged in the oropharynx, and in such cases indirect or fiberoptic laryngoscopy is the first clinical management option. For FBs that have passed beyond this location, radiologic study is recommended, including anteroposterior and lateral neck radiographs (LNRs) using the soft-tissue technique. This is a quick and simple imaging method that in emergency departments achieves detection rates of 70%-80% in assessing FBs in the hypopharynx and upper cervical esophagus. Careful initial evaluation using LNRs can determine the presence and nature of an FB, which helps with predicting the location and risk assessment, making further imaging-including computed tomography-unnecessary. Prevertebral soft-tissue swelling is a nonspecific indirect sign, which in the appropriate clinical context raises suspicion of a radiolucent FB or related complications. LNRs can sometimes be difficult to interpret due to the presence of multiple overlapping soft-tissue structures and variable patterns of laryngeal cartilage calcification in adults. Adequate performance in interpreting LNRs along with familiarity with the full diagnostic process in these patients will enable radiologists to use the right imaging technique for the right patient, as described in the clinical algorithm proposed by the authors. RSNA, 2017.
成人异物（FB）摄入比儿童少见，但仍会发生。急诊科对疑似FB摄入患者的诊断管理取决于FB的类型和位置，这两者均与患者情况相关。在成人中，鱼骨和鸡骨是最常见的FB类型，口咽和环咽肌是最常见的位置。一旦意外吞咽，FB可能会卡在上咽部，在这种情况下，间接喉镜或纤维喉镜检查是首要的临床管理选择。对于已通过该位置的FB，建议进行放射学检查，包括使用软组织技术的颈部正侧位X线片（LNR）。这是一种快速简单的成像方法，在急诊科评估下咽和上颈段食管的FB时，检测率可达70%-80%。使用LNR进行仔细的初步评估可确定FB的存在和性质，这有助于预测位置和进行风险评估，从而无需进一步的成像检查，包括计算机断层扫描。椎体前软组织肿胀是一种非特异性间接征象，在适当的临床背景下会引起对透X线FB或相关并发症的怀疑。由于成人存在多个重叠的软组织结构以及喉软骨钙化模式各异，LNR有时难以解读。如作者提出的临床算法所述，放射科医生在解读LNR方面具备足够能力并熟悉这些患者的完整诊断流程，将能够为合适的患者选择正确的成像技术。RSNA，2017年。
