March Week 4: Foreign Body
A 3 year old boy is brought in by mom to your clinic because he swallowed a coin 3 hours ago. Initially, he vomited 2-3 times but now is comfortable. Mom reports the she did not see the coin in the emesis.
How can you tell if the coin is in the trachea or esophagus? (Esophageal coins usually are seen en face on the
PA film and from the side on the lateral film; coins in the trachea are seen from the side on the PA and
en face on the lateral films.)
What are the most common locations that an esophageal foreign body can be lodged? (trachea, esophagus – proximal esophagus due to the change from skeletal to smooth muscle and the cricopharyngeus muscle, mid-esophagus where the aortic arch crosses over, and LES
Discuss how you would proceed. What if this was a different type of foreign body, ie a button battery, straight pin, or magnet? (allow FBs in esophagus at least 24 hrs to pass to stomach ie f/u cxr in clinic. Can try oral intake to help it move, but motility agents don’t work. Button battery in esophagus can cause liquefaction necrosis within hrs, need urgent removal via scope. Button batteries in stomach okay. Consider removal of straight pins longer than 4-6 cms bc they prob wont pass. Magnets can trap bowel between them and cause pressure necrosis. Rigid bronch ie ENT or pulm can retrieve, flexible scope ie GI cannot)
A 10 yo boy with severe developmental delay is brought to your office for cough. Mom reports the cough is non-productive, persistent, and she first noticed it when he got home from school 2 days ago. He has no congestion or nasal discharge, and his exam is normal. Mom reports he has had many foreign body ingestions in the past, especially small toys, sponges, and magnets.
What is your next step in diagnosis? (cxr)
Your workup comes back normal. What is your next step? (most objects are organic so radiolucent. Can see hyperinflation, atelectasis, or infiltrate on cxr or can be normal. Inspiratory/expiratory or decubital or soft tissue neck films can help or be normal. lack of findings never can be used to exclude an airway
foreign body. In this high risk pt consider referral for scope.