Diagnosis of Fish Bone Foreign Body in the Esophagus

Correct diagnosis of a fish bone foreign body in the esophagus is not easy mainly because the foreign body is, in many cases, radiolucent.Some important clues for the accurate diagnosis of a fish bone foreign body in the esophagus were reported as follows;1. The presence of radiating pain to the back or anterior chest on swallowing is suggestive of the presence of a foreign body.2. The elicitation of pain in the upper esophagus due to passive lateral movements of the thyroid cartilage is also suggestive of a foreign body in the hypopharynx or upper esophagus. Such pain is also known to occur in cases of cancer in the same regions.3. X-rays from different directions may show a suggestive shadow of a foreign body in the esophagus due to the thickness of the foreign object in a certain direction.Lateral views of the neck and the chest as well as routine posterior-anterior views, therefore, ought to be taken in order not to overlook a foreign body in the esophagus.4. A contrast study of the esophagus using diluted barium is quite helpful, since it often shows a minimal retention of the contrast medium, filling defects or other unusual changes in the esophageal mucosa at the site of a foreign body.