Pediatric emergency medicine trisk 0676 0676
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contrast material obscuring visualization on endoscopy. Computed tomography
(CT) scan may be considered in special circumstances. Children with a
predisposing condition (e.g., tracheoesophageal fistula repair, esophageal
stricture, eosinophilic esophagitis) are more likely to have esophageal food or
foreign-body impaction.
Handheld metal detectors have been used as an initial screen when coin
ingestion is suspected, as an alternative to radiographs. Though these devices
compare favorably with radiography in determining the presence or absence of a
coin and its location, they are less reliable in detecting other metallic objects and
detecting objects in obese patients. Users would need to gain experience with the
device using x-ray confirmation before abandoning radiography, and ensure
patient follow-up as some objects may be missed with this method.
FIGURE 32.3 Inspiratory and expiratory chest radiographs demonstrating air trapping in the
right lung during expiration, indicating likely right-sided foreign body. A peanut was removed
at bronchoscopy.
