A radiolucent esophageal foreign body : Diagnosis , management , and potential complications

IMAGING FINDINGS AP chest radiograph (Figure 1) demonstrated a subtle round radiolucent mass-like object projecting over the esophagus at the level of the C5-C6 interspace. AP and lateral neck radiographs (Figure 2) demonstrated the 2.4 cm radiolucent object with radial spoke-like lines extending peripherally. The object extends from the C4 to C6 vertebral bodies. The object appears to fill the esophageal lumen with prominent proximal esophageal dilatation and paraesophageal soft tissue edema resulting in mild focal narrowing of the trachea posteriorly. Gross specimen (Figure 3A) following open rigid laryngoscopic retrieval reveals a small intact plastic wheel from a toy truck, with impressive radiographic resemblance (Figure 3B).


CASE SUMMARY
An 8-year-old boy presented to the emergency department with odynophagia of secretions, dysphagia of liquids, and sialorrhea.His exam was negative for stridor, hypoxia, and aphonia.The patient was slightly tachycardic and afebrile.He had no relevant medical history or prior imaging.

IMAGING FINDINGS
AP chest radiograph (Figure 1) demonstrated a subtle round radiolucent mass-like object projecting over the esophagus at the level of the C5-C6 interspace.AP and lateral neck radiographs (Figure 2) demonstrated the 2.4 cm radiolucent object with radial spoke-like lines extending peripherally.The object extends from the C4 to C6 vertebral bodies.The object appears to fill the esophageal lumen with prominent proximal esophageal dilatation and paraesophageal soft tissue edema resulting in mild focal narrowing of the trachea posteriorly.
Gross specimen (Figure 3A) following open rigid laryngoscopic retrieval reveals a small intact plastic wheel from a toy truck, with impressive radiographic resemblance (Figure 3B).

Radiography plays a critical role in the diagnosis and management of
A radiolucent esophageal foreign body: Diagnosis, management, and potential complications R. Scooter Plowman, MD, MBA, MHSA; Logan Dance MD; Craig Barnes MD; Scott A. Jorgensen MD; Alexander J. Towbin MD; Richard Towbin MD ingested and aspirated FBs, especially in the pediatric population.Prompt radiologic recognition of impacted FBs is necessary for adequate treatment, as some ingested objects oblige emergent/ urgent retrieval (i.e.batteries, magnets, sharps, larger impacted objects).Quickly identifying the radiographic signs of impaction and aspiration is also crucial, especially as many FBs are radiolucent.While radiography remains the modality-of-choice in diagnosing ingested and aspirated FBs, fluoroscopy and enhanced CT can prove very helpful with radiolucency and other compli-cated cases.Complications of retained FBs include inflammation, obstruction, bleeding, abscesses, fistualization, strictures, or even death.Endoscopic retrieval may be necessary in up to 20% of cases.

FIGURE 3 .
FIGURE 3. (A) Gross specimen following open rigid laryngoscopic retrieval reveals a small intact plastic wheel from a toy truck.(B) Enlarged AP neck radiograph revealing striking resemblance to gross specimen.

FIGURE 1 .
FIGURE 1. AP chest radiograph demonstrating subtle round radiolucent mass-like object projecting over the esophagus at the level of the C5-C6 interspace (arrow).

FIGURE 2 .
FIGURE 2. AP and lateral neck radiographs better demonstrate the 2.4 cm radiolucent object with radial spoke-like soft tissue densities extending peripherally (arrows).The object extends from the C4 to C6 vertebral bodies.The object appears to fill the esophageal lumen with prominent proximal esophageal dilatation and paraesophageal soft tissue edema, resulting in mild narrowing of the posterior trachea.