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Ingested Button Batteries


KEY FACTS

Terminology

  • Ingestion of disc-shaped battery, typically by young child

    • Increasingly of more injurious lithium cell type

  • Esophagus particularly susceptible to injury by lodged battery with potentially catastrophic consequences

Imaging

  • Frontal radiograph: Margin shows double halo/ring en face

  • Lateral radiograph: Rim of step-off/beveled edge

    • Negative pole (narrower side): Site of anticipated most severe injury

  • North American Society for Pediatric Gastroenterology, Hepatology, & Nutrition imaging guidelines

    • Radiographic coverage from nasopharynx to anus

      • –

        Lateral view at least at site of confirmed foreign body

    • After emergent removal of esophageal battery

      • –

        CTA/MR if esophageal injury present to evaluate proximity/involvement of vascular structures

        • □

          CTA safest & most efficient vessel assessment

      • –

        Esophagram to exclude leak prior to advancing diet

    • Battery distal to esophagus: Management varies based on battery size & patient age

Clinical Issues

  • Caustic injury due to hydroxide radical production in tissues adjacent to negative pole

  • Unwitnessed ingestion more likely to present in delayed fashion with nonspecific symptoms: Vomiting, difficulty feeding, cough, chest or abdominal pain, drooling, stridor

  • ↑ risk of major complications: Unwitnessed ingestion, size ≥ 20 mm (majority lithium; radiographs overestimate size), age < 5 years old, multiple batteries ingested

    • Unwitnessed ingestion accounts for 92% of associated fatalities & 56% of major outcome cases

    • Complications include tracheoesophageal fistula, esophageal perforation, esophageal stricture, vocal cord paralysis, aortoenteric fistula (high fatality rate)

  • Injury evolves weeks after battery removal

Frontal radiograph of a 1 year old with acute cough, gagging, & emesis (but no witnessed ingestion) shows a 23-mm diameter disc-shaped foreign body with a double ring/halo
appearance in the proximal esophagus, consistent with a button battery.

Lateral radiograph of a 10 month old with a witnessed foreign body ingestion & subsequent drooling & emesis shows the circumferential edge step-off
typical of a button battery. The negative pole is the narrower anterior side
.

Lateral radiograph from a 7 year old after the known ingestion of a button battery (> 20 mm in diameter) > 12 hours prior to presentation shows that the button battery is impacted in the mid to distal esophagus. Beveled edges are seen
with the negative pole
directed anteriorly toward the left atrium.

Sagittal CECT from the same patient shows the esophageal battery posterior to the left atrium
. There is soft tissue thickening (inflammation) without evidence of fistula.

TERMINOLOGY

Definitions

  • Ingestion of disc-shaped battery, typically by young child

  • Esophagus particularly susceptible to injury by lodged battery with potentially catastrophic consequences

IMAGING

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