Should the type of fish bone ingested guide need for soft tissue neck Xray?
Date First Published:
May 30, 2012
Last Updated:
June 14, 2012
Report by:
Dr. Nadeem Crowe, FY2 (Royal Free Hospital)
Three-Part Question:
If [a patient comes in to the Accident and Emergency Department complaining of foreign body sensation in the throat after consuming fish], [does knowing the type of fish consumed impact on radio-opacity on plain radiograph] [and therefore help guide a clinician on need to refer on for endoscopy]?
Clinical Scenario:
A patient comes in to the accident and emergency department complaining of foreign body sensation after eating fish for dinner. The fish bone is not visible on soft tissue plain radiograph of the neck. Does knowing the species of the fish consumed help the clinician make a decision on referral for endoscopy?
Search Strategy:
Google scholar search
Search Details:
Fishbone + radio-opacity
Outcome:
78 results.
1 paper relevant to question and freely accessible. All other relevant search results citing this paper.
1 paper relevant to question and freely accessible. All other relevant search results citing this paper.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The radio-opacity of fishbones — Species variation S.R. Ell, A. Sprigg Aug-91 UK | Animal study - porcine neck | The radio-opacity of fishbones — Species variation. Assessed the agreement between junior doctors and consultants on visibility of fish bone in neck on plain radiograph. Assessed 14 species of fishbone and the relative ease of identification on plain radiograph. |
Correlation of fishbone visibility to junior doctors as compared to consultant surgeon | Highly significant positive correlation rs>0.93, P< 0.001) | Animal study - used pigs neck to simulate human neck |
| Most radio-opaque bones | Cole fish, gurnard, monk fish, plaice, red snapper, cod, haddock, grey mullet and lemon sole - clearly visible in all positions in pigs neck | ||||
| Least radio-opaque bones | herring, salmon, mackerel, trout and pike (p<0.001) - barely visible in all neck positions | ||||
| Site where bone most easily identified | Laryngopharynx | ||||
| Site most often missed | Tonsil and site obscured by angle of jaw |
Author Commentary:
If there is a clear history of fish consumption and foreign body sensation in the throat but no fishbone is visible on plain radiograph - knowing that some species of fish are not radio-opaque and may need endoscopic imaging may avoid missed diagnosis of lodged fishbone in the oropharynx/laryngopharynx
Bottom Line:
Knowing the species of fish consumed is a useful aid in the emergency room in guiding doctors on the need for endoscopic referral.
References:
- S.R. Ell, A. Sprigg. The radio-opacity of fishbones — Species variation