Presentation
Shocked ICU patient with SBO. End stage renal failure.
Patient Data
ETT in the lower trachea (had just been pulled back as had been in the RMB). NGT well positioned. Bibasal collapse. Bowel hyperdensities in keeping with lanthanum (phosphate binder for renal failure). Contrast in stomach is gastrografin.
New bilobed metallic structure projected in the superior mediastinum at the level of the ETT tip has an appearance of a molar tooth restoration. NGT remains well positioned.
A call was made to the ICU team and asked about any missing teeth. The team indicated the intubation had been traumatic the day before but they could not find an empty tooth socket although access to the patient's mouth was limited.
ETT and NGT remain well positioned. The molar tooth has now progressed into the stomach.
The patient proceeded to endoscopy.
A molar tooth was found in the stomach during endoscopy.
Case Discussion
Interesting case illustrating an esophageal tooth foreign body presenting after traumatic intubation and moving position into the stomach on serial CXRs.