Stiff Neck and Drooling in a Young Girl
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Published on: January 5, 2022
William B Prince1, Richard M Cantor2,3
1From the Emergency Medicine/Pediatrics.
Insights
A child swallowed a button battery, initially sent home, but later presented with neck pain and secretions. Imaging revealed the esophageal button battery and surrounding air, indicating a serious complication.
Area of Science:
- Pediatric Emergency Medicine
- Otolaryngology
- Radiology
Background:
- Button battery ingestion is a common pediatric emergency.
- Esophageal button battery impaction can lead to severe complications if not promptly identified and managed.
Observation:
- A 3-year-old girl presented with neck pain and pooling of secretions 4 days after a choking episode.
- Initial evaluation at another emergency department, including a chest X-ray, was normal, and the child was discharged.
- The patient was later diagnosed with pharyngitis and treated with amoxicillin.
Findings:
- A soft tissue neck X-ray revealed a 20-mm button battery lodged in the esophagus.
- Air lucencies in the prevertebral soft tissues indicated esophageal perforation or significant inflammation.
Implications:
- Delayed diagnosis of esophageal button battery impaction can lead to life-threatening complications such as perforation.
- This case highlights the importance of thorough evaluation and follow-up for suspected button battery ingestion, even with initially normal imaging.
- Prompt recognition and intervention are crucial for managing pediatric esophageal button battery foreign bodies.
Abstract:
A 3-year-old girl was brought to the emergency department 4 days after she was playing with a button battery and subsequently had a choking episode. The patient was seen immediately at a different emergency department and was discharged home after a normal chest x-ray finding and able to tolerate an oral challenge with liquids. She was later evaluated by her primary care physician and started on amoxicillin for possible pharyngitis. On examination in our emergency department, the patient had pooling of secretions and was unwilling to range her neck due to pain. Soft tissue neck x-ray confirmed a 20-mm button battery in the esophagus with air lucencies in the prevertebral soft tissues.
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