Presentation
A child was brought in with symptoms of drooling of saliva and irritability. The family reported that the child had ingested a foreign object, but they were unsure of what it was. A chest x-ray was ordered to determine the type and location of the foreign body.
Patient Data
Anteroposterior (AP) view: a radiopaque disc.
Lateral view (lat): step-off sign.
Case Discussion
Chest x-rays show a radiopaque disc in the anteroposterior (AP) view; however, the lateral view (Lat) reveals "a step-off sign" of the foreign body in the esophagus. The radiological findings for this case are not straightforward and made it challenging to differentiate between a coin and a button battery. The step-off sign indicates that the foreign object is a button battery, and the radiopaque disc indicates a coin. An urgent oesophagoscopy was performed, which revealed the presence of two different-sized coins that were overlapping with each other. In conclusion, the presence of a step-off sign in the lateral view of the X-ray is not exclusively for a button battery alone. It may also indicate the presence of two overlapping, different-sized coins.
Differential diagnosis for the step-off sign on the lateral view x-ray for foreign body ingestion:
button battery
overlapping two different-sized coins
The clinical message's importance lies in the need for clinicians to be cautious when they observe a step-off sign on the lateral view X-ray. It should prompt them to consider urgent intervention to prevent complications related to battery ingestion. However, if a single coin has been removed instead of a battery, they should revisit the case to ensure that no other coin has been missed in the esophagus or ascertain whether it has passed into the stomach.
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