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Chest, Head and Neck, Pediatrics

Pediatric Foreign Body Ingestion

History: Male child with a parent worried he swallowed a coin.

Penny in Esophagus: Frontal radiograph of the chest reveals a round radiopaque foreign body of metallic density projecting over the upper thoracic spine. Of note, the air filled trachea projects to the right of the foreign body and the lungs are clear and well expanded (indicating the foreign body is likely not obstructing the airway).

Penny in Esophagus: Frontal radiograph of the chest reveals a round radiopaque foreign body of metallic density projecting over the upper thoracic spine. Of note, the air filled trachea projects to the right of the foreign body and the lungs are clear and well expanded (indicating the foreign body is likely not obstructing the airway).

Penny in Esophagus: Lateral radiograph of the neck in the same patient reveals the ingest foreign body is posterior to the trachea, which is patent. This confirms the location of the penny in the lower cervical esophagus.

Penny in Esophagus: Lateral radiograph of the neck in the same patient reveals the ingest foreign body is posterior to the trachea, which is patent. This confirms the location of the penny in the lower cervical esophagus.

This is a case of pediatric foreign body ingestion. The most common pediatric foreign body ingestion is a coin, and in this case the coin was a penny. Pennies commonly lodge within the lower cervical esophagus, at the level of the thoracic inlet, as in this case. The maximum diameter of the coin is typically oriented left to right as opposed to anterior-posterior.

Interestingly (and importantly), pennies made after 1982 are composed of both zinc and copper, according to Wealth Daily. This is important because zinc can react with the acidic environment of the stomach and cause mucosal ulcerations.

It is also important to distinguish coins from batteries in the case of pediatric foreign body ingestion. Battery edges have a beveled appearance on end as opposed to the flat, simple edges of coins. In the case of ingested batteries, urgent removal by endoscopy or inflated Foley catheter balloon under fluoroscopic guidance is indicated. Why? Because batteries can cause mucosal ulcerations. Read about treatment here.

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About radiologypics

I am a radiology physician from California, USA.

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  1. Pingback: Pediatric Foreign Body Ingestion – Battery | RADIOLOGYPICS.COM - March 25, 2013

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