Sagittal orientation of ingested coins in the esophagus in children

The classic teaching has been that coins in the esophagus are oriented in the coronal plane projecting en face on frontal radiographs and tangentially on lateral views, whereas coins in the trachea are oriented sagittally and appear tangential on frontal radiographs and en face on lateral radiographs. We evaluated the clinical presentation and radiographic appearance in eight cases of esophageal coins in children with an atypical sagittal orientation on chest radiographs.

The clinical records and chest radiographs of eight children with sagittally oriented esophageal coins were retrospectively reviewed. Patient age, sex, type of coin, location of the coin within the esophagus, method of coin removal, presence of underlying esophageal anomalies, treatment, and complications related to the coin ingestion or removal were recorded.

The age of the eight children ranged from 3.8 to 17.7 years (mean, 7.8 years). The coins were lodged at the level of the aortic arch in seven of the eight patients and at the level of the distal third of the esophagus in one patient. In one of the eight cases, the coin was originally in the sagittal plane but spontaneously reoriented into the coronal plane.

Our case series reveals that the classic teaching that coins with a sagittal orientation on chest radiographs are in the trachea is usually not correct. A coin seen with a sagittal orientation on a chest radiograph will likely be within the esophagus.