Coins are the most common foreign body swallowed by children younger than five years old. Initial clinical manifestations may include cough, drooling, choking, pain, dysphagia, and occasionally dyspnea and stridor (secondary to compression of the trachea). Pain, fever, and shock are suggestive of esophageal perforation. Esophageal foreign bodies are associated with a number of complications, including lacerations, perforations, impaction, and irritation following removal.
Symptomatic patients should be treated by endoscopy both to remove the object and to examine the esophagus for mucosal injury. Alternative measures include observation for 24 hours with the expectation that the coin will pass, foley catheter may be passed distal to the coin, the balloon inflated, and coin removed with the catheter, or bougie used to push the foreign body into the stomach.
Esophagus versus Trachea
1. Coronal orientation of coin on PA film. If the coin were in the trachea, one would expect a sagittal orientation because the incomplete cartilaginous rings of the trachea open posteriorly.
2. Evidence of air trapping or obstruction.
3. Airway compromise(cough, wheeze, respiratory distress).
4. Lateral view