Impacted food bolus | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Impacted food bolus

Images from upper GI examination show an impacted food bolus (arrow) within the distal esophagus. Impacted food bolus is most commonly associated with eosinophilic esophagitis. Other underlying causes of a food bolus impaction are related to entities that cause esophageal stricture. Eosinophilic esophagitis is an immune or antigen-mediated esophagitis.

Similar cases

Lateral (image 1) and frontal (image 2) views from an esophagram in a patient with abrupt onset of dysphagia after eating meat show an obstructive filling defect in the proximal esophagus. Food bolus impaction is associated with eosinophilic esophagitis and prior esophageal surgery. A mucosal biopsy is recommended at the time of endoscopy due to the high incidence of eosinophilic esophagitis in patients with this finding. #ThoraxThursday #ThoracicThursday

Pt with an extensive history of esophageal food bolus obstructions. This is an image from his EGD. Any guesses?

Images from a fluoroscopic esophagram in a patient with eosinophilic esophagitis show a focal narrowing (arrow) within the mid-esophagus. The area of narrowing also has a ringed appearance. Eosinophilic esophagitis is an immune-mediated or allergen-mediated esophagitis. Patients present with dysphasia, vomiting, abdominal pain, and/or food impaction. The diagnosis is with endoscopy and biopsy showing more than 15 eosinophils per high-powered field. While an esophagram is usually normal, potential findings include strictures, a diffusely narrowed esophagus, and esophageal rings.

A frontal radiograph (image 1) post-esophageal atresia repair shows a mediastinal bulge (arrow) displacing the trachea (arrowhead) to the left. An esophagram reveals a food bolus within the dilated proximal esophageal pouch (arrow). There is a small amount of aspiration outlining the tracheobronchial tree (arrowhead). Esophageal strictures are common following esophageal atresia repair. The stricture can lead to food bolus impaction.