Toxic Ingestion — Imaging Studies — Clinical Pathway: Emergency Department, ICU and Inpatient

Toxic Ingestion Clinical Pathway — Emergency Department, ICU and Inpatient

Imaging Studies

  • Imaging studies are not routinely recommended for all ingestions
  • Utilize clinical judgment in test selection
  • Review situation-specific considerations below
Abdominal X-ray
  • Known or suspected radiopaque substance ingestion
    • Examples:
      • Iron, lead, metallic foreign bodies (coins, magnets)
      • Calcium carbonate tablets, potassium tablets
  • Note: Radiopaque substances may not appear on X-ray due to size or angle of image
  • Concern for abdominal complications from ingestion
    • Example:
      • Bowel perforation from caustic ingestion
Airway X-ray
  • Cases of caustic ingestions with upper airway symptoms
    • Examples:
      • Stridor
      • Drooling
Chest X-ray
  • Cases where there is a high-risk aspiration or inhalation of a substance
    • Examples:
      • Low-viscosity hydrocarbons (gasoline, kerosene, paint thinners)
      • Caustic substances
      • Small particulates
      • Irritant gases (Cl2, NO2, COCl2)
  • Concern for pulmonary complications from ingestion, inhalation, or aspiration
    • Examples:
      • Pulmonary edema from salicylate toxicity
      • Esophageal perforation from caustic substances
CT and MRI
  • Use to evaluate complications from poisonings as clinically indicated
    • Example:
      • Head CT for altered mental status
  • Can be used to diagnose an ingestion or poisoning in rare circumstances
    • Example:
      • Body packer syndrome
  • Note: Consultation with Poison Control Center/toxicologist is recommended to discuss if urgent or follow-up advanced imaging is warranted based on ingested substance
Ultrasound
  • May be helpful in characterizing complications of ingestions
    • Examples:
      • Soft tissue edema
      • Bowel dilation
  • Note: Not routinely recommended for diagnosis or triage of ingestions