A 2-year-old is brought after a suspected ingestion episode. Chest radiograph shows a round radiopaque object at the level of the cricopharyngeus. On the frontal view it appears as a circle, and the lateral view demonstrates a distinct step-off between the two halves of the disc. Which statement about the ingested object is correct?

• A It is a coin, and conservative observation for spontaneous passage is appropriate
• B It is a marble, and serial radiographs weekly will document passage
• C It is a button battery, and endoscopic removal within hours is mandatory because of liquefaction necrosis ✓
• D It is a ring magnet, and removal can wait until elective listing

Explanation

The step-off between two halves on the lateral film is the classic double-contour appearance of a button battery, distinguishing it from a coin, which shows uniform thickness on both views. A battery lodged in the esophagus generates hydroxide ions at the negative pole, causing liquefaction necrosis, perforation, and fistulization into the great vessels within hours. Endoscopic removal is therefore an emergency, unlike an asymptomatic esophageal coin which allows a brief period of observation.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.