Oesophageal coins invisible on chest radiography: a case report

Associated Data

Data Availability Statement
not applicable

Abstract

Background

Coins are made of metallic, which is broadly radiopaque, and indeed physicians often have the misconception that all coins are detectable by radiography. hera, we report a case of intentionally swallowed coins in the esophagus of an pornographic ; the coins could not be detected on chest of drawers radiography but were detected using computed imaging ( CT ) .

Case presentation

A 46-year-old womanhood with a history of depression presented to the emergency department after an intentional medicine overdose and consumption of two japanese 1-yen coins. She complained of dogged retrosternal discomfort. In decree to confirm whether the coins were in the esophagus or trachea, an anteroposterior chest radiogram was obtained ; however, no coins were detected. Owing to her haunting symptoms, a thorax CT was performed. On the initial CT scan, two 1-yen coins were observed in the esophagus : one in the in-between esophagus and the early in the lower esophagus. After the scan, the affected role drink water with license, but vomited. No coins were found in her vomit, and the symptoms of retrosternal discomfort had wholly disappeared. A subsequent CT scan revealed that the two 1-yen coins were in the patient ’ s stomach.

Conclusions

japanese 1-yen coins are made of 100 % aluminum, which is less radiopaque than the metals that make up coins ( nickel, bronze, and lead ), and so, they were not visible via chest radiography in our shell. Detecting very small or thinly radiolucent foreign bodies is not possible using a chest radiogram or contrast oesophagram, but is possible via CT. CT is both increasingly convenient and non-invasive, unlike endoscopy or bronchoscopy, and so, the use of CT scans should be considered in cases of potential radiolucent foreign body consumption. Keywords:

Oesophageal coins, Radiolucent, CT scan

Background

Swallowed foreign bodies can include respective objects, with coins being the most coarse in children. Coins are made of metal, which is generally radiopaque, and so, physicians often have the misconception that all coins are detectable by radiography. here, we report a case of intentionally swallowed coins in the esophagus of an pornographic ; the coins could not be detected on thorax radiography but were detected using computed imaging ( CT ) .

Case presentation

A 46-year-old womanhood with a history of depression presented to the hand brake department after an intentional medicine overdose and consumption of two japanese 1-yen coins. On physical examination, the patient was drowsy owing to an overdose of benzodiazepines and quetiapine ; however, her full of life signs were within the normal compass. There were no abnormal lung sounds and no abdominal tenderness. One hour after her presentation, the affected role was alert and oriented, after which she complained of persistent retrosternal discomfort. She did not report dyspnea or dysphagia. In decree to confirm whether the coins were in the esophagus or trachea, an anteroposterior breast radiogram was conducted ; however, no coins were detected ( Fig. ). The aesculapian team suspected that the coins had already traversed to the stomach or lower gastrointestinal tract, or that she had not swallowed any coins. however, owing to her persistent symptoms, a chest CT was performed. On the initial CT scan, two 1-yen coins were observed in the esophagus : one in the middle esophagus and the other in the lower esophagus ( Fig. ) .An external file that holds a picture, illustration, etc.
Object name is 12245_2017_153_Fig1_HTML.jpgOpen in a separate windowAn external file that holds a picture, illustration, etc.
Object name is 12245_2017_153_Fig2_HTML.jpgOpen in a separate window After the scan, the patient drink water with license, but vomited. No coins were found in her vomit, and the symptoms of retrosternal discomfort had completely disappeared. A second CT scan revealed that the two 1-yen coins were in the patient ’ s stomach. Because there was no need for treatment, the patient was discharged. Two days late, at the follow-up appointee, the affected role reported that the coins had been discharged in her faeces .

Conclusions

Swallowed alien bodies can consist of diverse items, including small toys, button batteries, press-through packs, and artificial tooth. Coins are the most common foreign bodies found in children [ 1 ]. Coins are made of versatile metals, such as nickel, bronze, and lead, which are generally radiopaque and can be detected via radiography. The x-ray concentration of a coin depends on its composition, concentration, and the atomic number of the metal. japanese 1-yen coins are made of 100 % aluminum, which has an atomic number ( Z ) of 13, compared to nickel and lead, with Z values of 28 and 82, respectively. The atomic number for aluminum is between that of the cram ( calcium, Z = 20 ) and of the soft tissue ( Z = 7.5 ). It is consequently very difficult to distinguish aluminum from other soft tissues [ 2, 3 ]. In our case, 1-yen coins could not be detected by thorax radiography.

A few studies have reported cases of aluminium-based alien bodies. Khan reported a case in which a Pakistani 2-rupee mint, besides made of aluminum, was faintly visible on a chest of drawers radiogram [ 4 ]. Kotsenas et aluminum. reported a case in which the aluminum pull check from a beverage can was aspirated and was not detectable via chest radiography. The pull tab key was detected in a chest of drawers CT scan 7 months late [ 2 ]. extra reasons for the invisibility of 1-yen coins on the chest radiogram in this particular case include the direction of the X-rays and the location of the coins. In the esophagus, the coin was located horizontally in relation back to the torso. This horizontal position separates the mint from other mediastinal structures or the pectoral spine on a lateral chest of drawers radiogram. In addition, the coin could be more well visualised owing to its thickness in this place. A line oesophagram may besides be effective for identifying radiolucent alien bodies in the esophagus, while besides exposing the patient to less radiation [ 5 ]. however, contrast oesophagrams do not possess adequate diagnostic accuracy compared with CT scans, come with a contrast-aspiration gamble, and may compromise subsequent endoscopies ascribable to the contrast application of the alien body and oesophageal mucous membrane [ 6 ]. It is impossible to detect the presence of a very little or thin radiolucent extraneous torso on a breast radiogram or contrast oesophagram. For such cases, lone a computerized tomography scan can detect a radiolucent extraneous consistency in the esophagus. CT scans are both commodious and non-invasive, unlike endoscopy or bronchoscopy. therefore, CT scans should be considered in cases of possible radiolucent foreign body consumption .

Acknowledgements

We would like to acknowledge our ED staff for their support .

Funding

No fund was required in homework of the manuscript .

Availability of data and materials

not applicable

Abbreviations

CT Computed tomography
Z Atomic number

Authors’ contributions

JT, HF, and TS drafted the case presentation and edited the manuscript. All authors read and approved the final manuscript .

Notes

Ethics approval and consent to participate

Study approval was obtained from the Institutional Review Board at Tokyo Bay Urayasu Ichikawa Medical Center. The affected role has provided permission to publish these features of her shell .

Competing interests

The authors declare that they have no competing interests .

Publisher’s Note

Springer Nature remains neutral with attentiveness to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Jin Takahashi, Email : moc.liamg @ 100700fshst. Takashi Shiga, Email : moc.liamg @ pmeagihskat. Hiraku Funakoshi, Email : pj.en.bewofni.bm @ 4570shwf .

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