Diagnostic Accuracy of Lateral Neck Radiography for Esophageal Foreign Bodies in Adults

Abstract

OBJECTIVE. The objective of our study was to evaluate the accuracy of signs on lateral neck radiography for the assessment of patients with suspected esophageal foreign bodies (FBs). MATERIALS AND METHODS. This retrospective study was conducted of 235 adult patients between January 2012 and December 2017. Group 1 was composed of 95 patients with esophageal FBs, and group 2 was composed of 140 patients without esophageal FBs. Four signs on lateral neck radiography were recorded in both groups: presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, and increased prevertebral soft-tissue thickness. The prevertebral thickness was also evaluated in three groups of patients categorized by patient age: 19-29 years old, 30-59 years old, and 60 years old or older. RESULTS. The accuracy of the presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, and increased prevertebral soft-tissue thickness was 84.3%, 66.8%, 54.0%, and 60.9%, respectively. Combined two signs of presence of radiopaque density with air column lucency provided the highest accuracy, 90.6%. The prevertebral thickness at C6 of group 1 was 14.28 ± 3.19 mm (mean ± SD), and the prevertebral thickness at C6 of group 2 was 13.34 ± 2.54 mm (p = 0.018). CONCLUSION. Lateral neck radiography is helpful for the initial evaluation of patients with suspected esophageal FBs. The presence of radiopaque density or air column lucency provided the highest practical diagnostic value. Loss of cervical lordosis, as a single diagnostic sign, did not seem to provide a diagnostic advantage. Despite the variations in values for the three age groups, clinicians should be alert regarding increased prevertebral thickness at C6 especially when it is more than 20 mm.

Keywords: cervical lordosis; esophagus; foreign body; lateral neck radiography; prevertebral thickness.