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Should the type of fish bone ingested guide need for soft tissue neck Xray?

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
Fishbone + radio-opacity

Search Outcome

78 results.
1 paper relevant to question and freely accessible. All other relevant search results citing this paper.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
S.R. Ell, A. Sprigg
August 1991
Animal study - porcine neckThe 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 surgeonHighly significant positive correlation rs>0.93, P< 0.001)Animal study - used pigs neck to simulate human neck
Most radio-opaque bonesCole 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 bonesherring, salmon, mackerel, trout and pike (p<0.001) - barely visible in all neck positions
Site where bone most easily identifiedLaryngopharynx
Site most often missedTonsil and site obscured by angle of jaw


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

Clinical 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.


  1. S.R. Ell, A. Sprigg The radio-opacity of fishbones — Species variation Clinical Radiology Volume 44, Issue 2, August 1991, Pages 104-107