-Case Reports-

Use of 3-Dimensional Computed Tomography to Detect a Barium-Masked Fish Bone Causing Esophageal Perforation

Atsushi Tsukiyama, Takashi Tagami, Shiei Kim and Hiroyuki Yokota

Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital

Computed tomography (CT) is useful for evaluating esophageal foreign bodies and detecting perforation. However, when evaluation is difficult owing to the previous use of barium as a contrast medium, 3-dimensional CT may facilitate accurate diagnosis. A 49-year-old man was transferred to our hospital with the diagnosis of esophageal perforation. Because barium had been used as a contrast medium for an esophagram performed at a previous hospital, horizontal CT and esophageal endoscopy could not be able to identify the foreign body or characterize the lesion. However, 3-dimensional CT clearly revealed an L-shaped foreign body and its anatomical relationships in the mediastinum. Accordingly, we removed the foreign body using an upper gastrointestinal endoscope. The foreign body was the premaxillary bone of a sea bream. The patient was discharged without complications.

J Nippon Med Sch 2014; 81: 384-387

Keywords
barium contrast, fish bone, foreign body perforation, esophagus, 3-dimensional computed tomography

Correspondence to
Takashi Tagami, MD, PhD, Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
t-tagami@nms.ac.jp

Received, January 18, 2014
Accepted, March 27, 2014