10 month old female throwing up…

July 3, 2013

Chest XR, Non-Trauma, Respiratory, XR


This child was referred to the ED after an astute primary care doctor got a chest xray in the setting of a week of throwing up after eating:

FB 2Coin 1

The PA/LAT chest xray views above show a radioopaque object near the thoracic inlet.  The object resembles the shape and size of a penny.  Interestingly, on the lateral it almost looks like two pennies lying on top of each other.  The patient was taken to the OR and esophagoscopy was used to pull two pennies out of her upper esophagus. 

On xray, how can you differentiate between tracheal and esophageal foreign bodies?

Author:  Russell Jones, MD

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2 Comments on “10 month old female throwing up…”

  1. docskalski Says:

    Foreign bodies of the esophagus are more posterior, and in this case you can clearly see the patent trachea anterior to the pennies. Is there another trick to differentiating the two? Great case! 🙂

    Reply

    • emrems411 Says:

      Yes! The lateral view definitely differentiates esophageal and tracheal in this situation. Also consider the lie of the coin in the coronal plane. The esophagus is usually flattened behind the rigid trachea and a coin in this plane suggests esophageal. The trachea, on the other hand has rigid cartilage surrounding most of the ringed structure except for the posterior aspect. Coins tend to be in the sagittal plane when they are in the trachea because the posterior portion is malleable.

      Sent from my iPhone

      Reply

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