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A Case Report of a Coin Stack Masquerading as a Button Battery
Peyton J Ware1, Carter Ware1,2, Amanda H Bjornstad1,3
1Loma Linda University School of Medicine, Laboratory for Innovations in Medical Education, Loma Linda, CA.
Journal of Education & Teaching in Emergency Medicine
|August 6, 2026
Summary
Coin stacks can mimic button batteries on X-ray, presenting a diagnostic challenge. Urgent removal is recommended for esophageal foreign bodies showing button battery signs to prevent severe injury.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Gastroenterology
Background:
- Esophageal foreign bodies (FB) in children often require transfer for removal.
- Coins are common pediatric FBs, but button batteries (BBs) pose a higher risk of severe injury.
- Radiographic signs like the halo and step-off signs are characteristic of BBs.
Purpose of the Study:
- To highlight a case where a coin stack (CS) mimicked a button battery (BB) on imaging.
- To emphasize the importance of distinguishing between BBs and other radiographically similar FBs.
- To recommend a management strategy for esophageal FBs with concerning radiographic signs.
Main Methods:
- Case report of a pediatric patient transferred for suspected BB ingestion.
- Review of radiographic findings, including halo and step-off signs.
- Description of the urgent removal and identification of the esophageal foreign body.
Main Results:
- A six-year-old female presented with symptoms and radiographic signs (halo, step-off) suggestive of a BB.
- The esophageal foreign body was urgently removed and identified as a coin stack (two coins).
- This case demonstrates a coin stack mimicking a button battery.
Conclusions:
- Coin stacks can radiographically resemble high-risk button batteries.
- Due to imaging similarities and potential for severe injury, coin stacks should be managed similarly to button batteries.
- Urgent removal of esophageal foreign bodies with button battery-like radiographic signs is crucial, with definitive identification post-operatively.
