Impacted Chicken Bone in Esophagus

• Soft tissue measurements on the lateral neck image
  • At C3: <3 mm (less than 1/3 AP diameter)
  • At C6: < the AP width of C6 vertebral body
    
    
• Impacted esophageal foreign bodies 
  
          
  • Food or true foreign bodies
    • Chicken bones (opaque), fish bones (non-opaque)
    • Coins, toy trucks
  • Most often they impact just below cricopharyngeous (70%)
    • Another 20% impact at the level of the aortic arch
    • Another 10% at EG junction
    • Once past the esophagus, most foreign bodies will pass through the GI tract
      
      
• Clinical findings of an impacted esophageal foreign body
  
  
  • Dysphagia and odynophagia most commonly
  • Even if FB passes, many complain of pain referable to cervical esophagus
    
    
• Imaging Findings
  
  
• Always check for lead lines in children
  • Pica
• Chicken bones are usually opaque
  • Fish bones contain less calcium and usually are not
• Plain films usually do not demonstrate the FB but are still obtained first
  • If negative, then either contrast esophagram or CT if high index of suspicion
    
    
• Treatment
  
  
  • Removal is most often performed using endoscopy
  • Temporization and surgery are other options
  • An ingested button battery lodged in esophagus must be removed immediately
    
    
• Complications of an impacted foreign body
  
  
  • Perforation
    • Longer the FB remains impacted (>24hrs), higher incidence of perforation
  • Stricture
  • Diverticulum formation

 
Impacted Foreign Body. Lateral radiograph of the neck demonstrates a linear density in the region of the proximal esophagus (red arrow) consistent with an impacted foreign body--in this case, a chicken bone. There is no air in the soft tissues and no soft tissue swelling is identified to indicate the presence of a retropharyngeal abscess.