Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Ingested Coins


KEY FACTS

Imaging

  • Disc-shaped metallic density without circumferential beveled edge/step-off

  • Most common sites of impaction

    • Upper esophagus at thoracic inlet

    • Midesophagus at aortic arch impression

    • Lower esophageal sphincter at gastroesophageal junction

  • Other sites of impaction include pylorus, duodenum, ileocecal valve

  • Imaging recommendations

    • Screening frontal radiographs of neck through pelvis ± lateral view of upper airway

    • Targeted lateral radiograph if foreign body identified

Top Differential Diagnoses

  • Button battery ingestion

  • Magnet ingestion

  • Various other foreign bodies

Clinical Issues

  • Majority of ingestions by children < 5 years old

  • Most common symptoms

    • Asymptomatic: Witnessed ingestion or incidental finding

    • Symptomatic: Drooling, chest/neck pain, vomiting, dysphagia, cough, respiratory distress, stridor

  • 25-30% of esophageal coins pass spontaneously: More likely if further distal in esophagus on early imaging

  • Treatment of esophageal coins: Urgent endoscopic removal if symptomatic; endoscopic removal within 24 hours if asymptomatic (with repeat radiograph prior to endoscopy to verify position)

  • Treatment of coins in stomach: Monitor stools for passage; repeat radiograph in 2 weeks → endoscopic removal if not passed in 2-4 weeks

  • Treatment of small bowel coins: Observation; endoscopic/surgical removal if symptomatic

  • Complications uncommon: Esophageal stricture, perforation, aortoesophageal or tracheoesophageal fistulas

Frontal radiograph of the lower chest in a 2 year old with emesis shows a 19.5-mm metallic disc, consistent with a coin, projecting over the distal esophagus. The disc was found to be a dime at endoscopy. Radiographs cannot accurately identify coin types based on size.

AP radiograph shows a coin lodged in the cervical esophagus. Note that the coin is wider than the trachea, indicative of an esophageal location. The erosions
are due to gastroesophageal reflux reaching a zinc-based coin.

Lateral radiograph demonstrates a metallic coin in the proximal esophagus at the thoracic inlet. There is soft tissue swelling
between the coin and the trachea with associated tracheal narrowing
. These findings suggest a more chronic foreign body that may be difficult to remove.

Lateral airway radiograph in a 2 year old after a witnessed ingestion shows 2 directly apposed coins
projecting over the upper esophagus at the thoracic inlet. This appearance can mimic the edge step-off of a button battery.

IMAGING

General Features

  • Location

    • Most common sites of impaction

      • –

        Upper esophagus at thoracic inlet

      • –

        Midesophagus at aortic arch impression

      • –

        Lower esophageal sphincter (LES) at gastroesophageal junction

    • Other sites of impaction include pylorus, duodenum, ileocecal valve

  • Size

    • United States coins

      • –

        Penny (1 cent): 19 mm

      • –

        Nickel (5 cents): 21 mm

      • –

        Dime (10 cents): 18 mm

      • –

        Quarter (25 cents): 25 mm

    • Radiographic measurements may not allow accurate coin identification due to magnification & small differences in coin diameters

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts