A 2 year old male presents with his mother with after mom saw him put something metallic in his mouth. He has no past medical problems and does not appear in any distress. His lung sounds are clear bilaterally, SpO2 99% on room air. You obtain a PA and lateral radiograph.

Can this child be safely discharged home with anticipatory guidance?

It is likely that the object is in the esophagus given the orientation on PA and lateral views. Had it been in the trachea it, the flat portion would be seen on lateral view as that is the only orientation a coin can fit through the cords. However, you should always obtain a CLOSE-UP view of the object. In this case you can see a rim around the edge of the object indicating its actually a button battery and not a coin.

Batteries located in the esophagus need to be removed emergently because of the risk of esophageal burns and resultant complications, within 2 hours of ingestion when possible.

Courtesy of Keith Borg MD MUSC Children’s hospital.