Hot Seat #154: Denouement

Posted on: June 11, 2020, by :

The case: a 16mo with concern for foreign body aspiration

Here’s how you answered the questions:

Discussion:

The features that make this case interesting: 1. Multiple consulting services with differing takes on management (and which service is going to be responsible for taking this thing out?) and 2. A scary x-ray finding in a very well appearing child. While the order in which services were consulted differed, everyone agreed that this child needed scoping, the majority agreeing that an endoscopy and bronchoscopy in the OR was the best course of action. Interestingly, the attendings were more likely to advocate for reaching out to the surgery attending, while the fellows were more likely to get another consultant’s opinion. The timing of the esophagram was debated, as some would get it before consulting ENT, GI, or surgery, while others noted the difficulty in getting esophagrams overnight and this may not be an option.

To address Dr. Agrawal’s question below, foreign body ingestions includes both foreign object ingestion (screws, coins, batteries, etc) AND esophageal food impaction (the diagnosis of concern in this patient).

Denouement: After a discussion with radiology and general surgery, the decision was made to obtain an esophagram prior to a CT.  The esophagram showed a normal airway and normal esophagus with no concern for retained foreign body. The patient then successfully tolerated a PO trial of liquids and solids and was discharged home with no further interventions.

The information in these cases has been changed to protect patient identity and confidentiality. The images are only provided for educational purposes and members agree not to download them, share them, or otherwise use them for any other purpose.

Mary Beth Howard

Pediatric Emergency Medicine Fellow at Children's National Health System
Mary Beth Howard

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