A 2 year old F presents to the ED with her parents with concern that she may have ingested a coin. Patient is well appearing with normal vital signs and exam. A CXR is obtained. What's the diagnosis? (scroll down for answer)

Answer: Esophageal Foreign Body (coin at level of GE junction)

• Coin in espophagus is en face on AP film vs. trachea en face on lateral film 
• Es-O-phagus on AP film
• Indications for emergent EGD
• ingestion of sharp or elongated objects/multiple foreign bodies
• button battery ingestion- perforation can occur within 6 hours!
• evidence of perforation
• coin at level of cricopharyngeus muscle in child
• airway compromise
• presence of FB > 24 hours
• EGD Is contraindicated in body packers and can be rapidly fatal
• Distal to pylorus and benign shape- expectant management
• Can attempt glucagon to facilitate passage if object in distal esophagus; 1-2mg IV for adult, can repeat in 20 min if no relief (low success rates reported)

References:

Mendelson, M. “Esophageal Emergencies.” Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8th Ed. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016.