UMEM Educational Pearls

Category: Visual Diagnosis

Title: What's the Diagnosis? Case by Dr. Zachary Dezman

Posted: 9/16/2013 by Haney Mallemat, MD
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8 year-old girl presents with dysphagia and drooling, Xray is shown. What’s the diagnosis (and where is it located)?

A coin located in the esophagus at the level of the cricopharyneus muscle

Foreign body (FB) pearls

The cricopharyngeus muscle is the most common site of esophageal obstruction in children
An "end-on" or a “slit-like" appearance on PA CXR sugggests a foreign body in the trachea
A “double-ring” sign would identify a button battery rather than a coin
FBs should generally be removed, or seen to pass into the stomach, before ED discharge. In this case, however, there were signs of obstruction (drooling) so the risk of perforation is high.
Items in the proximal third of the esophagus should be removed emergently via endoscopy.

Kenton, Foreign Bodies in the Gastrointestinal Tract and Anorectal Emergencies, Emerg Med Clin N Am 29 (2011) 369–400

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