UMEM Educational Pearls

Question

5 year-old boy who presents with sudden onset hoarse voice, and drooling without a fever. 

Answer

Coin lodged in the esophagus

Coin ingestions

  • More than 100,000 foreign body ingestions are reported in children each year; coins are #1 cause
  • Although not always 100% true, coins typically appear circular on an AP Xray of the neck when in the esophagus and linear when in the trachea
  • Coins usually pass without issue, but warning signs are drooling, dysphagia, hoarse voice, wheezing, or stridor
  • 10-20% require endoscopy for removal and 1% require surgery
  • Objects lodged in the middle esophagus should raise concern for underlying pathology such as strictures, masses, or webs

References

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Waltzman ML, Baskin M, Wypij D, Mooney D, Jones D, Fleisher G. A randomized clinical trial of the management of esophageal coins in children. Pediatrics. 2005;116(3):614.

Cevik M, Gókdemir MT, Boleken ME, Sogut O, Kurkcuoglu C. The characteristics and outcomes of foreign body ingestion and aspiration in children due to lodged foreign body in the aerodigestive tract. Pediatr Emerg Care. 2013;29(1):53.