Application of point-of-care ultrasound for different types of esophageal foreign bodies: three case reports: A CARE-compliant article

Abstract

Rationale: Esophageal point-of-care ultrasound (POCUS) has recently been reported as a useful, quick, safe, and simple technique to detect esophageal foreign bodies (FBs). However, case series to detect esophageal FB using POCUS have been rarely reported. Chicken bones and pills, especially, have not yet been reported as esophageal FBs. The objective of this case series was to describe the POCUS findings of 3 different materials-food, pill, and chicken bone.

Patient concerns: Case 1, a 75-year-old woman with odynophagia and neck pain occurring 30 min after eating chicken porridge; Case 2, a 32-year-old woman with neck discomfort occurring 2 h after taking a pill; Case 3, a 29-year-old woman reporting FB sensation in the neck that occurred 1 h after eating sausage and rice soup.

Diagnosis: Case 1. Cervical esophageal FB (chicken bone), Case 2. Cervical esophageal FB (oral pill), Case 3. Cervical esophageal FB (food).

Interventions: Case 1. POCUS, urgent esophagogastroduodenoscopy (EGD) with alligator forceps. POCUS findings; hyperechoic material (suspected FB) that did not disappear by swallowing and esophageal dilatation with pooling of secretions. Case 2. POCUS. POCUS findings; hypoechoic material (suspected FB) that did not disappear by swallowing, and esophageal bulging above the FB, especially observed in the longitudinal view. Case 3. POCUS. POCUS findings; hyperechoic material (suspected FB) with reverberation artifact that did not disappear with swallowing efforts. Prior FB esophageal bulging with persistent air-fluid level was especially observed in the longitudinal view.

Outcomes: Case 1. FB was removed by EGD with alligator forceps. Case 2. Symptoms disappeared under observation without EGD. Follow-up POCUS revealed normalized bulging esophagus. Case 3. These symptoms improved after vomiting a large piece of food material. Three patients were discharged without complications.

Lessons: In this case series, the impacted materials were chicken bone, pill, and food. However, POCUS findings were similar (esophageal dilation, hyperechoic or hypoechoic lesion with mixed echogenic contents in food or secretion, and no change with swallowing efforts). A longitudinal view was useful to assume the presence of cervical esophageal FB in all three cases. Thus, POCUS findings could be indirect signs of a FB in the esophagus.

Figure 1

A 75-year-old woman (case 1) with complaint of odynophagia and neck pain that occurred 30 min after eating chicken porridge. Simple neck lateral radiography showing radiopaque material suspected as FB (black arrow). FB = foreign body.

Figure 2

A 75-year-old woman (case 1) with complaint of odynophagia and neck pain that occurred 30 min after eating chicken porridge. POCUS view of chicken bone. (A) Axial view showing dilated esophagus and hyperechoic material suspected as FB (white arrow). (B) Longitudinal view showing hyperechoic material suspected as FB (white arrow). FB = foreign body, POCUS = point-of-care ultrasound.

Figure 3

A 32-year-old woman (case 2) with discomfort on neck that occurred 2 h after taking a pill. The white arrow in each figure indicates the structure such as trachea and esophagus. The name of the structures is written at the end of the arrow or above the structure. (A) Axial view showing bulging esophagus due to impaction of pill. (B) Axial view showing collapsed esophagus after the pill went down. (C) Longitudinal view showing focal bulging esophagus due to impaction of pill. Dash line outlines the esophagus. (D) Longitudinal view showing collapsed esophagus after the pill went down. Dash line outlines the esophagus. (E) Simulated sonographic image of a pill. After the latex glove was filled with water, a pill was placed under the glove and the probe was placed on the glove to obtain a sonographic image of the pill. The pill was shown as hypoechoic lesion in the ultrasound.

Figure 4

A 29-year-old woman (case 3) with FB sensation on neck that occurred 1 h after eating sausage and rice soup. The white arrow in each figure indicates the structure such as trachea and esophagus. The name of the structures is written at the end of the arrow or above the structure. (A) Axial view showing bulging esophagus with pooling of secretion and hyperechoic material suspected as food. (B) Longitudinal view showing hyperechoic material suspected as FB with reverberation artifact that did not disappear by swallowing efforts and esophageal bulging. FB = foreign body.