Just Say 'No' to X-Ray

A 27-year-old woman came into the ED in the middle of the night complaining of not being able to sleep. She was sure the continuous right-sided foreign body sensation under the angle of her jaw came from a fish bone stabbing her during a late-night dinner. A CT revealed an embedded fish bone. ENT removed the foreign body endoscopically, and she was discharged on oral antibiotics, and had an uneventful follow-up visit a few days later.     The question with my residents always seems to be, "Should we get an x-ray?" And my answer now is, "No."   It is certainly possible that careful inspection of the oral cavity (directly or indirectly) could identify a bone sticking out of a tonsil or base of the tongue. Looking and finding something can make a difference. Unfortunately, overlying mucous can easily hide a fish bone.   Plain x-rays, on the other hand, have quite a few problems. These objects can be easily missed depending on the angle of a tiny embedded fish bone. Normal calcifications also can be mistaken for foreign bodies. Plain radiography generally is confusing and adds little value for most patients with fish bones stuck in the throat.   When I am concerned about a fish bone stuck in the throat that I cannot see, my next step is uncontrasted CT.           The little bit of bone sticking out at the mucosal surface could be easily missed with inspection, especially for the inexperienced. In addition, it is shocking to see h...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs