4 years old child with sudden onset of unexplained



Doctor's Information

Name :  Mehdi
Family :Bitarafan
Email :  ----------------
Resident :  Hussein Soleiman Tabar


Patient's Information

Gender :  Male
Age :  4


Case Section

Pediatric Radiology


Clinical Summary

4 years old child with sudden onset of unexplained drooling from 2 hours earlier.



Imaging Procedures and Findings

A coin is seen in lower neck. Its coronal orientation represents it lodges in esophagus (not in trachea). There is no inflammation or pneumomediastinum.



Radiopaque foreign bodies are easily identified on plain radiographs. Smooth objects, such as coins, the most commonly ingested foreign bodies, usually are seen at the thoracic inlet. Less commonly, they will stop at the level of the left main stem bronchus or just above the esophagogastric junction. If coins are seen at other levels, underlying esophageal abnormalities should be considered. Sharp objects, pins being the most com- mon, may present anywhere along the course of the esophagus if they penetrate mucosa. Food, plastic and aluminum articles, and buttons are the most common nonopaque esophageal foreign bodies. Plain radiographs of the chest and neck (including a lateral view of the upper airway that includes the nasopharynx, because foreign bodies can be placed in the nose or can reflux into the nasopharynx once placed in the mouth) should be the first imaging examination. Coins in the esophagus lie in the coronal plane, while those in the trachea lie in the sagittal plane, presumably because of the anatomy of the tracheal rings. Longstanding foreign bodies may have perforated, leading to pneumomediastinum or mediastinal mass. A foreign body such as incompletely chewed food may cause high-grade ob- struction with air-fluid levels in the esophagus or a frothy appearance from mixed air and fluid. Impacted food most often occurs in patients who have underlying esophageal abnormalities. Nonopaque foreign bodies may require esophago- grams for diagnosis. Because the degree of potential obstruction is unknown before the examination, only a small amount of opaque material should be given initially. Spot images should be obtained in anteropos- terior and lateral views. Contrast studies generally are not performed when an opaque foreign body is identi- fied; however, they may be useful if there is concern about edema, stricture, or perforation. Low-osmolarity contrast should be used in such cases.


Final Diagnosis

Coin in esophagus



Caffey's pediatric diagnostic imaging-l0th ed./[edited by] jerald P. Kuhn, Thomas L.Siovis,jack O. Haller.


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