A Toddler With Persistent Crying and a Coin Overlying the Upper Mediastinum

A 2-year-old boy presented to the emergency department with 6 h of increased fussiness, persistent crying, and apparent chest discomfort. There was no witnessed foreign body ingestion. He was alert, in no acute distress, and had no stridor, drooling, or increased work of breathing. Anteroposterior chest radiography demonstrated a round radiopaque foreign body overlying the upper mediastinum (Fig 1). Radiographic interpretation raised concern for tracheal versus upper esophageal location. Because transfer to a higher level of care was required for removal, the emergency physician performed a bedside neck ultrasound (Videos 1-3; Figs 2 and 3).