Abdominal X-ray for Chicken Bone Ingestion
Abdominal x-ray has limited utility for chicken bone ingestion due to false-negative rates up to 85%, and CT scan should be performed instead in symptomatic patients or those with high clinical suspicion. 1
Why Plain X-ray is Inadequate
- Chicken bones are poorly radiopaque and frequently missed on plain radiography, with false-negative rates reaching 85% for chicken bones specifically 1
- Even when visible, plain x-rays cannot adequately assess for complications such as perforation, penetration, or abscess formation 2
- The overall false-negative rate for esophageal foreign bodies is up to 47%, making plain radiography unreliable for ruling out ingested foreign bodies 1, 3
The Correct Imaging Approach
CT scan is the imaging modality of choice for suspected chicken bone ingestion, with the following performance characteristics:
- CT has 90-100% sensitivity and 93.7-100% specificity for detecting foreign bodies 1, 3
- CT is essential for locating the bone, evaluating complications (perforation, abscess, obstruction), and guiding management decisions 1, 2
- CT can identify secondary signs of perforation even when the bone itself is subtle, including free air, fluid collections, and inflammatory changes 2
When to Obtain CT Imaging
Proceed directly to CT scan in the following scenarios:
- Any symptomatic patient with suspected chicken bone ingestion, regardless of x-ray findings 1, 3
- Patients with persistent symptoms (dysphagia, chest pain, abdominal pain, odynophagia) despite negative x-ray 1, 3
- High clinical suspicion based on history, even with negative plain films 1
- Signs suggesting perforation: peritoneal irritation, fever, leukocytosis 4, 2
Role of Ultrasound
- Ultrasound can successfully diagnose chicken bone perforation and may be superior to CT for characterizing the shape and length of the foreign body through multiaxial real-time imaging 5
- Ultrasound can detect secondary signs of perforation (fluid collections, inflammatory changes) even when the bone is not directly visualized 2, 5
- Consider ultrasound as a complement to CT, particularly for follow-up or when CT findings are equivocal 5
Critical Pitfalls to Avoid
- Never rely on a negative x-ray to exclude chicken bone ingestion in symptomatic patients 1, 2
- Do not delay CT imaging while waiting for symptoms to resolve, as complications like aortoesophageal fistula can be fatal 6
- Chicken bones can cause delayed perforation days to weeks after ingestion, requiring ongoing vigilance even after initial negative imaging 4, 6
- Sharp chicken bone fragments in the esophagus require emergent endoscopy within 2-6 hours due to high perforation risk 1, 3