Pediatric foreign body ingestion (button battery)
Recommended: AP and Lateral CXR + Abdominal X-ray is the preferred imaging study for pediatric foreign body ingestion (button battery). Button battery in esophagus is an emergency — endoscopic removal within 2 hours.
Recommended study
AP and Lateral CXR + Abdominal X-ray
Button battery in esophagus is an emergency — endoscopic removal within 2 hours. 'Halo' or 'double-ring' sign distinguishes from coin.
If the default doesn't apply
Concern for perforation / mediastinitis post-removal
CT
CT Chest with IV contrast
IV contrast
Watch-outs
Esophageal battery beyond 2 hours
Risk of liquefactive necrosis, tracheoesophageal fistula, aortoesophageal fistula — life-threatening.
Honey administration pre-removal
Some protocols recommend honey for esophageal batteries to delay tissue damage (children > 1 year).
Pearls
- Coin vs button battery: button battery shows 'halo' / 'double-ring' on AP and 'step-off' on lateral.
- Magnets + battery is especially dangerous (bidirectional pressure necrosis).
- After esophageal removal, image at 7–14 days to evaluate for delayed complications (TEF, strictures).