Pictorial Essay | Emergency Radiology

eISSN 2005-8330
https://doi.org/10.3348/kjr.2025.0118
Korean J Radiol 2025;26(7):638-649

Foreign Body Ingestion: Radiologic Evaluation, Findings,

and Management
Sang Min Lee1, Song-Ee Baek2, Choong Wook Lee3, Young Chul Kim4, Min-Jeong Kim5
1
Department of Radiology, CHA University, CHA Gangnam Medical Center, Seoul, Republic of Korea
2
Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
3
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
4
Department of Radiology, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
5
Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea

Foreign body ingestion and sensation are common clinical conditions encountered in emergency and outpatient settings.
True foreign body ingestion typically involves a history of swallowing a foreign object and is often confirmed by radiographic
findings. The management of foreign body ingestion depends on the type, size, and location of the object, as well as the
patient’s symptoms. High-risk objects, such as button/disk batteries, multiple magnets, and sharp objects, often require
urgent or emergent endoscopic removal to prevent severe complications such as perforation, obstruction, and fistula
formation. Imaging is crucial for diagnosis and management, with radiographs being the first-line modality and CT offering
superior sensitivity for detecting radiolucent objects and complications. Mimickers of foreign body ingestion and sensations,
even without the presence of an actual foreign body, arise from motility disorders (e.g., achalasia), structural or mucosal
abnormalities (e.g., Zenker’s diverticulum, reflux esophagitis, and esophageal strictures), and extrinsic compression.
Although these mimickers produce similar symptoms, they require different diagnostic approaches. This review highlights the
radiological findings, management strategies for various foreign bodies, and the distinguishing features of their mimickers,
emphasizing the importance of timely and accurate differentiation to guide appropriate interventions and improve patient
outcomes.
Keywords: Foreign body; Ingestion; Mimickers; Sensation; Imaging

INTRODUCTION chronic symptoms and are generally managed in outpatient

settings. However, chronic symptoms may arise from
Foreign body ingestion is a frequent cause of emergency ingestion of foreign bodies embedded in the gastrointestinal
room visits, and patients often present with the sensation (GI) tract, leading to granuloma formation. Radiological
of a foreign body. True foreign body ingestion is typically findings play an essential role in distinguishing true foreign
characterized by a history of swallowing an object, as body ingestion from other conditions, thereby guiding
confirmed by radiographic imaging, and commonly presents appropriate diagnosis and treatment. This review focuses
with acute symptoms such as dysphagia. By contrast, on the radiological evaluation and management of foreign
foreign body sensations without ingestion tend to result in body ingestion. It also briefly describes the conditions that
mimic a foreign body sensation.
Received: January 27, 2025 Revised: April 9, 2025
Accepted: April 10, 2025
Corresponding author: Min-Jeong Kim, MD, PhD, Department Brief Epidemiology
of Radiology, Hallym University Sacred Heart Hospital, 22
Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Republic
of Korea
Foreign body ingestion can occur at any age; however,
• E-mail: drkmj@hallym.or.kr it is most common in pediatric populations [1]. It is the
This is an Open Access article distributed under the terms of leading cause of mortality from unintentional injuries
the Creative Commons Attribution Non-Commercial License
among children under one year of age. In adults, foreign
(https://creativecommons.org/licenses/by-nc/4.0) which permits
unrestricted non-commercial use, distribution, and reproduction in body ingestion occurs in patients with preexisting
any medium, provided the original work is properly cited. pathologies, such as esophageal stricture or cancer [2].

638 Copyright © 2025 The Korean Society of Radiology

Imaging of Foreign Body Ingestion

It occurs more frequently in older adults, patients with the most commonly ingested foreign bodies, followed by
psychiatric disorders or mental retardation, or those in button/disk batteries (17.2%), marble stones (6.6%), and
prison for secondary gain [1,3]. Approximately 10% of adult magnets (6.1%).
cases involve the intentional ingestion of foreign bodies [4].
Patients with foreign body ingestion may present with Evaluation of Foreign Body Ingestion:
various symptoms including dysphagia, odynophagia, foreign Role of Imaging Modalities
body sensation, chest or abdominal pain, and vomiting
[1,3]; however, some patients remain asymptomatic [4]. Imaging modalities enable the diagnosis of foreign body
Patients with poor communication skills, such as children ingestion and, consequently, guide clinical management.
and those with mental health problems, may present with Radiography is the recommended first-line imaging modality
hypersalivation, refusal to eat, and irritability. Occasionally, for the detection of foreign body ingestion. Bidirectional
aspiration of saliva or tracheal compression by a foreign neck, chest, and abdominal radiographs can be obtained
body can result in respiratory symptoms such as choking, based on the clinical findings [3,7]. Radiographs can
stridor, or dyspnea [1]. Complications associated with effectively identify the type, size, and location of swallowed
foreign body ingestion include bowel perforation [5] and objects, particularly radiopaque (in this article, the terms
obstruction, fistula formation, and sepsis. More severe ‘radiopaque’ and ‘radiolucent’ refer to plain radiography
complications include perforation of the pharynx or features) objects (Table 1) [7]. However, radiographs are
esophagus, which is associated with high mortality. less effective for the initial evaluation of non-radiopaque
A large-scale, single-center study in China [2] showed ingested foreign bodies [8], including food boluses, fish
that the type of foreign body ingested varied depending bones, glass fragments, plastic materials, and wooden
on the patient’s age. While coins are the most commonly items [1]. Serial imaging of radiographs enables tracking
ingested foreign body in children under 14 years of age, of the movement of radiopaque foreign bodies (Fig. 1) [7].
fish bones and dental prosthetics or food boluses are most Radiography also facilitates the detection of complications
common among individuals aged 15–59 years and those due to foreign objects, including pneumomediastinum and
over 60 years, respectively. Further, a multicenter study in pneumoperitoneum, which are indicative of pharyngeal and
Korea [6] investigating 424 pediatric endoscopic foreign upper GI tract perforations, respectively. Additionally, lateral
body removal procedures found that coins (45.3%) were neck radiographs play an important role in determining

Table 1. Representative examples of radiopaque and radiolucent foreign objects

Opacity of the objects* Examples
Radiopaque objects (usually delineated on radiographs) Batteries, magnets, coins, pins, dental prosthesis, scissors, blade, and wire
Radiolucent objects (rarely delineated on radiographs) Food bolus, fish or chicken bones, wood, plastic, glass, and thin metal objects
*‘Radiopaque’ vs. ‘radiolucent’ refers to plain radiography features

A B C D
Fig. 1. A 22-year-old woman with a swallowed hairpin that was traceable by serial radiographs. A, B: A radiograph (A) showed a hairpin
located in the left upper quadrant of the abdomen, which was subsequently identified within a small bowel loop on non-contrast CT
(B). C: A radiograph obtained two days later revealed migration of the hairpin to the lower right abdomen. D: The foreign body was
successfully retrieved from the ascending colon during colonoscopy.

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A B
Fig. 2. A 67-year-old man complaining of foreign body sensation after eating chicken. A, B: A chest radiograph (A) showed no abnormal
radiopaque foreign bodies. However, the coronal contrast-enhanced CT image (B) revealed a chicken bone (arrow) lodged in the esophagus.

A B C D
Fig. 3. A 49-year-old man with fever complained of a foreign body sensation after swallowing a denture. A, B: Antero-posterior (A)
and lateral (B) neck radiographs revealed a denture with sharp margins posterior to the trachea. Note the prevertebral widening and
emphysema (arrow) in the lateral view of the neck. C, D: Axial (C) and coronal (D) contrast-enhanced CT images of the neck showed the
denture impacted in the hypopharynx, accompanied by an abscess resulting from perforation of the left pyriform sinus (arrows).

the widening of the prevertebral soft tissue, suggestive of foreign body ingestion, including thickened wall, stranding
edema or inflammation, possibly caused by foreign body in adjacent soft tissues, and the presence of air outside the
impaction and perforation of the pyriform sinuses and lumen, while also allowing for direct visualization of foreign
cervical esophagus [7]. bodies within an abscess (Fig. 3) [7,11].
CT, often considered to be a secondary imaging modality,
offers greater sensitivity for identifying foreign objects, Management of Foreign Body Ingestion
particularly radiolucent objects (Fig. 2) [9]. Visualization of
foreign objects depends on the opacity of the objects and Most foreign objects naturally exit the GI tract without the
density of the surrounding tissues [7]. Three-dimensional need for intervention. Nevertheless, approximately 10%–20%
reformations also enhance foreign body visualization [10]. of foreign body ingestion cases necessitate endoscopic
CT enables the evaluation of complications, preprocedural extraction, whereas surgical removal is essential in only 1%
planning, and direct visualization of foreign bodies [7]. CT of cases [9]. Several organizations, including the European
can show findings related to bowel perforation owing to Society of Gastrointestinal Endoscopy (ESGE), American

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Imaging of Foreign Body Ingestion

Society for Gastrointestinal Endoscopy (ASGE), and North Table 2. Timing of endoscopic intervention for foreign body ingestion
American Society for Pediatric Gastroenterology, Hepatology, according to ESGE guideline, ASGE guideline, and NASPGHAN guideline
and Nutrition (NASPGHAN), have suggested clinical Object type Location Timing*
guidelines for managing foreign body ingestion [1,9,12]. Any object Esophagus with Emergent
obstruction symptoms
The approach used depends on the type, size, location,
Button/disk battery Esophagus Emergent
and duration of foreign body ingestion. Additionally,
Stomach/small bowel Urgent
patient age and symptoms, such as dysphagia, pain, or
Coin Esophagus Non-urgent
signs of perforation, should also be considered. Endoscopic Stomach/small bowel Non-urgent†
interventions for ingested objects are classified into three Magnet Esophagus Urgent
timing categories based on the risk of complications: Stomach/small bowel Urgent
emergent (within 2 hours), urgent (within 24 hours), and Sharp object Esophagus Emergent‡
non-urgent (within 72 hours) [1]. Stomach/small bowel Urgent
Common high-risk objects, including button/disk Long object (>6 cm)§ Esophagus Urgent
batteries, magnets, and sharp objects, often warrant Stomach/small bowel Urgent
ǁ
Wide object (>2.5 cm) Esophagus Urgent
emergent endoscopic removal (<2 hours), particularly
Stomach/small bowel Non-urgent
in cases of complete obstruction, sharp objects in the
Food bolus Esophagus Urgent
esophagus, or button/disk batteries in the esophagus [1,9].
*Emergent, urgent, and non-urgent require interventions within 2,
Urgent endoscopic removal (<24 hours) is required for sharp 24, and 72 hours, respectively, †According to NASPGHAN guideline,
objects in the stomach or duodenum, and multiple magnets removal of coin in the stomach can be delayed up to 2–4 weeks
or long objects in the stomach [1,9,12]. Furthermore, non- in an asymptomatic patients, ‡According to NASPGHAN guideline,
a sharp object in esophagus without symptoms requires urgent
urgent endoscopic removal (<72 hours) is warranted in endoscopic removal, §According to the ESGE guideline, a long
asymptomatic cases of non-threatening objects entering object is defined as >5–6 cm, whereas other guidelines define it as
the small bowel [1]. Table 2 summarizes the timing of the >6 cm, ǁAccording to the ESGE guideline, a wide object is defined
as >2–2.5 cm, while other guidelines use >2.5 cm as the threshold.
endoscopic intervention for foreign body ingestion [1,9,12].
ESGE = European Society of Gastrointestinal Endoscopy, ASGE =
American Society for Gastrointestinal Endoscopy, NASPGHAN =
Specific Foreign Bodies North American Society for Pediatric Gastroenterology, Hepatology
and Nutrition
Button/Disk Batteries
Button (also referred to as disk) batteries are commonly supported by reports of aortoesophageal fistulas caused by
used in various portable electronics such as watches, button battery ingestion that have been confirmed by CT
hearing aids, remote controls, calculators, toys, and medical angiography, leading to appropriate and timely treatment
devices. The incidence of battery ingestion has increased, and patient survival [18,19].
making it a common form of foreign body ingestion in the Button batteries are typically confused with coins during
pediatric population [13,14]. imaging. Therefore, differential diagnosis is important
Button batteries leak alkaline solutions and cause because the ingestions of these two objects are managed
rapid liquefaction necrosis owing to corrosion, resulting in different ways. Button batteries appear as “halo”
in esophageal mucosal damage [7]. Larger button or double rim signs on frontal radiographs (Figs. 4, 5)
batteries (≥20 mm) are more likely to become lodged in [20]. In ambiguous cases, additional lateral projection
the esophagus, resulting in severe outcomes [13,15]. can help identify the “step-off sign,” which is another
Serious complications, including bowel perforation and pathognomonic for button batteries [20].
tracheoesophageal fistula formation, have been confirmed Once in the stomach, most button batteries
in some cases [16]; these cases require emergent spontaneously pass through the GI tract [9]. However,
endoscopic retrieval (<2 hours) [1,9]. Particularly, button batteries arrested in small bowel can cause mucosal
aortoesophageal fistulas can be fatal [17]; therefore, damage and complications. Therefore, button batteries below
NASPGHAN guidelines recommend CT angiography or MRI the esophagus should be monitored using radiographs every
when esophageal mucosal injury is suspected following 3–4 days. Furthermore, surgery should be considered if button
button battery removal [12]. These recommendations are batteries are suspected to be lodged in the small bowel [9,15].

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Halo sign (+) Step-off sign (+)

A
Halo sign (-) Step-off sign (-)

B
Fig. 4. Differential imaging features of button/disk batteries and coins. A, B: Frontal and lateral radiographic images of a button/disk
battery (A) showing the halo and step-off signs. In contrast, the radiographic images of the coin (B) did not show a halo or step-off sign.

A B C

D E F
Fig. 5. A 3-year-old child presenting with irritability and worsening cough. A: A chest radiograph showed a round object with peripheral
halo indicating a “halo sign” or “double rim sign” lodged at the level of the cervical esophagus. B: Endoscopy revealed a disk-shaped
button battery with a whitish exudate in the cervical esophagus. C: It was removed endoscopically. D: Endoscopy after removal showed
mucosal erosion with necrotic foci. E: A coronal contrast-enhanced CT image obtained after removal of the button battery showed
suspicious extraluminal air densities around the esophagus and extensive mediastinal edema abutting the trachea and left carotid artery (*)
arising from the aortic arch (aa). No definite tracheoesophageal or aortoesophageal fistulae were observed. F: Esophagography showed
bilateral diverticula (arrowheads) at the level of the previously impacted button battery without contrast leakage.

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Imaging of Foreign Body Ingestion

According to a retrospective study analyzing 2382 cause entrapment of the bowel between them, potentially
ingestions of cylindrical and button batteries, cylindrical leading to necrosis [7]. Severe complications associated
batteries were associated with a lower incidence of with multiple magnets, such as bowel necrosis, perforation,
ingestion and lower rates of major complications than and fistula formation (Fig. 8), necessitate the accurate
button batteries. Nevertheless, cylindrical batteries should determination of the number of ingested magnets [9,19].
be removed endoscopically when they are arrested in the In some cases, additional lateral imaging may assist in
stomach for more than 48 hours (Fig. 6) [9]. identifying multiple magnets [22].
According to the NASPGHAN guidelines, management
Coins strategies differ based on the number of magnets ingested
Coins are one of the most common foreign bodies [12]. Any magnet located in the esophagus or stomach
ingested by young children (Fig. 7) [9]. When should be urgently removed via endoscopy, even if only
asymptomatic, coins lodged in the esophagus and stomach a single magnet is present. Surgical intervention is
can be monitored for 12–24 hours and up to 2–4 weeks, warranted for symptomatic ingestion of multiple magnets
respectively, before proceeding to non-urgent endoscopic beyond the stomach. Conversely, if the single magnet is
retrieval [9,12,21]. Most coins traverse the GI tract without not removable with endoscopy, a conservative approach
causing an obstruction. However, emergent intervention is involving observation and follow-up with serial imaging is
required for the presentation of marked symptoms, such as recommended, alongside education on avoiding exposure
hypersalivation and stridor [9]. to external magnets and metals, as magnetic attraction to
them through body tissues can cause injury to the tissue
Magnets caught in between.
Magnets, which are commonly found in children’s toys,
pose significant risks as foreign objects and require urgent Sharp Objects
endoscopic removal. The ingestion of multiple magnets can Sharp objects present a higher risk of perforation

A B C D
Fig. 6. A 27-year-old prisoner with mild abdominal pain. A: An abdomen radiograph revealed two cylindrical batteries (arrow) in the mid-
abdomen without evidence of perforation or obstruction. B, C: Endoscopy (B) showed two AA-type cylindrical batteries in the stomach,
which were subsequently removed (C). D: Post-removal endoscopy revealed erosion and a whitish membrane, suggesting a corrosive injury.

A B C
Fig. 7. A 6-year-old boy who swallowed a 100-won coin. A: An abdominal radiograph revealed a round opacity in the mid-abdomen.
B: Subsequent endoscopy revealed a coin in the stomach, which was retrieved endoscopically. C: A photograph confirmed that the object
was a 100-won coin.

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A B C D
Fig. 8. A 16-month-old child with massive hematochezia. A: An abdominal radiograph showed seven small magnetic beads aligned in
a row at the L1-3 level. B, C: Although the evaluation was limited by streak artifacts, axial (B) and sagittal (C) CT images revealed
multiple magnetic beads in a row with anteroposterior projections from the stomach (S) to the proximal jejunum (J). D: An intraoperative
photograph shows magnetic beads penetrating the colonic mesentery.

than blunt objects. When ingestion of sharp objects significant risk of perforation owing to their sharp edges [5].
is suspected, their location should be determined [9]. They are also typically non-radiopaque, but may be detected
Sharp objects lodged in the esophagus require emergent on a CT scan (Fig. 10). Dental prostheses, including
endoscopic removal [1,9]. For objects located in the dentures and implant fixtures, can also be ingested inside
stomach or duodenum, urgent endoscopic removal should or outside dental clinics, and are frequently ingested by
be performed due to the high complication rate (35%) [1]. older adults (Fig. 11). These objects also result in severe
Sharp objects beyond the duodenum should be monitored complications such as small bowel perforation owing to
daily with radiographs, and surgery should be considered their sharp edges [31,32].
if no progression is observed radiographically for three
consecutive days [9,23]. Long and Wide Objects
Sharp objects include toothpicks, fish and chicken bones, Urgent endoscopy is also recommended for objects longer
drug packages, and dental prostheses. As most of these than 6 cm, such as toothbrushes and chopsticks, located in
objects are nonradiopaque, they are usually invisible on the esophagus or stomach (Fig. 12) [7,9]. Although long
radiographs. CT imaging is recommended when objects are objects (≥6 cm) rarely pass through the duodenum, they
difficult to detect on radiographs and complications are can penetrate the duodenum [33,34]. Endoscopic removal
suspected (Fig. 2) [24]. is recommended for objects wider than 2.5 cm, as they are
Toothpicks are made of plastic or wood, and ingestion unlikely to traverse the pylorus [9]. Furthermore, the ASGE
rarely occurs; however, they cause severe complications, guidelines recommend urgent and non-urgent endoscopic
including penetration of the liver, abdominal vessels, and removal of objects wider than 2.5 cm in the esophagus and
kidneys [25]. Fish bones are the most common accidentally stomach, respectively [9]. Anatomically narrowed areas, such
ingested foreign bodies among patients in South Korea as the pylorus, Treitz’s ligament, and ileocecal valves, impede
[11,26]. However, most of them spontaneously exit the GI the passage of long and wide foreign objects [7]. Therefore,
tract without any symptoms [27,28]. They are lodged in if such objects are arrested in these areas for >1 week,
the oral cavity or pharynx, particularly within the tonsils endoscopic or surgical removal should be considered [7,35].
or at the base of the tongue, and can be removed using a
scope. Complications are rare (<1% of cases); nevertheless, Food Bolus
fish bones are among the most common foreign bodies Food bolus impaction is another category of foreign
perforating the bowel, requiring surgery [11,29,30]. Like body ingestion [36]. Ingestion of non-food objects occurs
most sharp objects, they are typically non-radiopaque and are more commonly in children; however, food bolus impaction
therefore usually invisible on radiography. However, CT is a is more common in adults, especially older adults [2,37].
highly sensitive method for detecting fish bones (Fig. 9) [27]. Food boluses can lead to esophageal obstruction (Fig. 13)
Drug package blisters, pill packs, and foils ingested when and are mostly associated with underlying esophageal
older adults take medications are also associated with pathology, such as esophageal web, Schatzki rings, and

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Imaging of Foreign Body Ingestion

benign or malignant esophageal strictures [36,37]. A food of the underlying esophageal pathology, food bolus impaction
bolus in the esophagus can be removed endoscopically or may recur [8]. Biopsies are required to diagnose conditions
pushed into the stomach [1]. However, without confirmation like eosinophilic esophagitis, which is common underlying

A B C

D E
Fig. 9. A 62-year-old man complaining of foreign body sensation after eating rockfish. A: A lateral neck radiograph revealed a linear
hyperdense fish bone (arrow) in the prevertebral space. B: An abdominal radiograph showed a subtle hyperdense fish bone (arrow) in the
mid-abdomen, although it is not clearly visible. C: In contrast, a coronal contrast-enhanced CT image distinctly displayed a hyperdense
fish bone in the stomach, highlighting the superior sensitivity of CT in detecting fish bones compared with radiography. D, E: The fish
bones lodged in the esophagus (D) and stomach (E) were successfully removed endoscopically.

A B C
Fig. 10. A 66-year-old man complaining of foreign body sensation after taking medicine. A, B: A coronal image from a non-enhanced
chest CT scan (lung window) (A) revealed a sharp object (arrow) in the mid-esophagus that is not visible on the corresponding
radiograph (B). C: Subsequent endoscopy confirmed that the object was a blister pill foil.

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A B
Fig. 11. A 75-year-old woman complaining of foreign body sensation after swallowing a denture. A: The chest radiograph revealed a
subtle curvilinear radiopaque object (arrow) at the thoracic level. B: Coronal contrast-enhanced CT images demonstrated a hyperdense
curvilinear structure (arrow) within the mid-esophagus, consistent with an ingested denture.

A B C D
Fig. 12. A 55-year-old woman with a history of schizophrenia who ingested a toothbrush. A, B: Chest radiographs revealed the outline
of a plastic toothbrush (arrows) posterior to the trachea. Radiopaque wires securing the nylon bristles were visible, whereas the plastic
portion of the toothbrush was not apparent on radiography. C: An axial non-contrast CT image displayed the toothbrush (arrow)
within the esophagus. D: Owing to the length of the object, urgent endoscopic intervention was performed to successfully remove the
toothbrush.

pathology of esophageal food impaction that appears normal foreign body ingestion include motility disorders, structural
on endoscopy [38,39]. Follow-up diagnostic workups, including or mucosal abnormalities, and extrinsic compression of the
endoscopic biopsy and esophagography, are recommended to pharynx and esophagus (Table 3).
determine the underlying esophageal pathology [1]. Motility disorders such as achalasia present with
dysphagia, regurgitation, and chest pain due to impaired
Conditions Mimicking Foreign Body Ingestion esophageal motility and lower esophageal sphincter
relaxation, which can be confirmed by esophagography,
Various conditions can mimic foreign body ingestion, showing a dilated esophagus with beak-like narrowing
causing symptoms such as dysphagia and foreign body [40,41]. Diffuse esophageal spasms cause symptoms similar
sensation. These conditions can be challenging to to chest pain, with simultaneous contractions observed on
distinguish from foreign body ingestion, particularly in esophagography as a corkscrew pattern [42,43].
cases of radiolucent foreign bodies. Conditions mimicking Structural or mucosal conditions include Zenker’s

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A B

C D
Fig. 13. A 63-year-old man visited the emergency room complaining of a foreign body sensation. A: An unenhanced axial CT image
revealed a circular air-containing hyperdense object in the distal esophagus. B: Coronal contrast-enhanced CT showed dilatation of the
esophagus proximal to the object. C, D: Endoscopic examination identified the object as a chestnut, which was subsequently removed.

Table 3. Types of mimickers for foreign body ingestion

Motility disorder Achalasia, diffuse esophageal spasm
Structural or mucosal disorder Zenker’s diverticulum, esophageal stricture, reflux esophagitis, candida esophagitis, eosinophilic esophagitis
Extrinsic compression Extrinsic mass (e.g., thyroid disease, metastatic lymphadenopathy)
Cardiovascular compression (e.g., aberrant right subclavian artery)
Musculoskeletal process (e.g., osteophytes, diffuse idiopathic skeletal hyperostosis)

diverticulum, which results in dysphagia and regurgitation detected on radiological imaging such as CT [41].
due to mucosal herniation in the hypopharynx, which is
visible on fluoroscopy [44]. Esophageal strictures can be CONCLUSION
benign (e.g., peptic strictures from gastroesophageal reflux
disease [GERD] and radiation injury) or malignant (e.g., The evaluation of patients reporting foreign body
esophageal cancer) [41,45,46]. Esophageal cancer can be sensations in the emergency room necessitates accurate
identified by esophagography using infiltrative, ulcerative, differentiation between true foreign body ingestion and
polypoid, or varicoid patterns [41,47]. Reflux esophagitis, mimickers as they require different treatment guidelines.
which is also linked to GERD, may cause a foreign body Early diagnosis and intervention are critical for reducing
sensation, with esophagography revealing thickened folds morbidity and mortality in cases of true foreign body
and reflux [48]. Candida esophagitis, often observed in ingestion. Imaging modalities, including radiography and
immunocompromised patients, appears as longitudinally CT, can be used to detect and characterize foreign bodies.
oriented plaques on esophagography, whereas eosinophilic Additionally, CT helps confirm complications and facilitates
esophagitis, which is associated with allergies, shows procedural planning. Timely endoscopic removal is critical in
concentric ring-like strictures on esophagography [41,49]. cases involving ingestion of button batteries, magnets, sharp
Extrinsic compression from masses, such as thyroid disease, objects, and long objects. Furthermore, when no foreign body
metastatic lymphadenopathy, cardiovascular issues (e.g., is found on imaging or endoscopy in patients complaining of
aberrant subclavian artery), or musculoskeletal conditions foreign body sensation, there is a possibility of motility or
(e.g., osteophytes), can also cause dysphagia, which can be structural abnormalities in the pharynx or esophagus.

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Conflicts of Interest ingestion of a blister pill pack in an elderly patient. BMJ Case
The authors have no potential conflicts of interest to Rep 2015;2015:bcr2015212822
6. Lee YJ, Lee JH, Park KY, Park JS, Park JH, Lim TJ, et al.
disclose.
Clinical experiences and selection of accessory devices for
pediatric endoscopic foreign body removal: a retrospective
Author Contributions multicenter study in Korea. J Korean Med Sci 2023;38:e2
Conceptualization: Sang Min Lee, Song-Ee Baek. Investigation: 7. Guelfguat M, Kaplinskiy V, Reddy SH, DiPoce J. Clinical
all authors. Methodology: Sang Min Lee, Min-Jeong Kim. guidelines for imaging and reporting ingested foreign bodies.
Supervision: Min-Jeong Kim. Visualization: Sang Min Lee. AJR Am J Roentgenol 2014;203:37-53
Writing—original draft: Sang Min Lee. Writing—review & 8. Pfau PR. Removal and management of esophageal foreign
bodies. Tech Gastrointest Endosc 2014;16:32-39
editing: all authors.
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