From the Guidelines
The best initial imaging for a patient with something stuck in their throat is a plain neck, chest, and abdominal radiograph, specifically biplanar radiography including anteroposterior and lateral views, to assess the presence, location, size, shape, and number of ingested objects and possible signs of perforation 1. When evaluating a foreign body stuck in a patient's throat, it's crucial to consider the limitations of plain radiography, which has a false-negative rate of up to 47%, and even higher for certain types of objects like food bolus impaction, thin metal objects, or glass fragments 1.
- Key considerations for imaging choice include:
- The nature of the suspected foreign body
- Clinical signs of complications such as perforation or abscess formation
- The patient's ability to undergo different types of imaging
- For patients with suspected perforation or other complications, or when plain radiographs are negative but clinical suspicion remains high, a CT scan of the neck without contrast is recommended due to its high sensitivity and specificity for detecting both radiopaque and radiolucent foreign bodies, as well as its ability to visualize complications 1.
- It's also important to note that contrast swallow studies are not recommended as they can delay other investigations and interventions, and may increase the risk of aspiration or impair endoscopic visualization 1.
From the Research
Imaging Options for Foreign Objects in the Throat
- Computed Tomography (CT) scans can be used to assess the location and extent of the foreign object in the throat 2.
- Endoscopy, particularly ultrathin endoscopy, has been shown to be safe and effective in detecting anastomotic leaks and other abnormalities in the throat, with high sensitivity and specificity 3.
- CT fluoroscopy can be used in conjunction with endoscopy to provide added precision and guidance for difficult interventions in the throat 4.
- Other imaging modalities, such as X-ray, positron emission tomography (PET), magnetic resonance imaging (MRI), and diagnostic sonography, may also be used to evaluate the throat, but their effectiveness for detecting foreign objects is not well established in the provided studies.
Comparison of Imaging Modalities
- Ultrathin endoscopy has been shown to be more accurate and reliable than CT scans for detecting anastomotic leaks in the throat 3.
- Endoscopic ultrasonography (EUS) has been shown to be more accurate than CT scans and ultrasonography for diagnosing pancreatic cancer and assessing locoregional spread 5.
- The choice of imaging modality may depend on the specific clinical scenario, the availability of equipment and expertise, and the patient's individual needs and characteristics 2, 4, 6, 3, 5.