Question

A baby playing was left unattended by the mother develops distress. Identify where the object is [Images show PA and lateral chest X-rays with a round radio-opaque foreign body in the midline]

• A. Oesophagus
• B. Trachea
• C. Below diaphragm
• D. GI tract

Hint:

On a PA chest X-ray, a coin lying en face (full circle visible) with the trachea anterior to it on the lateral view localises it to the oesophagus, not the trachea.

Answer 1

The Correct Option is A

Step 1: Identify the clinical scenario. An unattended baby develops respiratory or swallowing distress after playing, suggesting foreign body ingestion or aspiration. The X-rays show a radio-opaque round object (consistent with a coin).

Step 2: Localise the foreign body using radiological criteria.

• PA (frontal) view: A coin in the oesophagus appears as a round disc (en face) -- the full circular face is visible because the oesophagus is a flat tube that allows the coin to lie flat.
• Lateral view: On the lateral X-ray, a coin in the oesophagus appears as a linear/rectangular opacity (edge-on view); the trachea appears anterior to the coin on the lateral view, confirming the coin is NOT in the trachea but posterior to it -- i.e., in the oesophagus.
• The object is located in the midline just above the aortic knob, which corresponds to the level of the thoracic oesophagus.

Step 3: Distinguish oesophageal from tracheal foreign body.

• A coin in the trachea appears edge-on on the AP view (trachea is a rigid ring that holds the coin on its edge) and en face on the lateral view -- exactly opposite to oesophageal position.
• In this case, the coin exceeds the diameter of the trachea on the AP view and the trachea is anterior on the lateral -- confirming oesophageal location.

Step 4: Conclusion. The foreign body is in the oesophagus.