Question

Which of the following may be true in this patient

• A. Oesophagus is the correct site
• B. Most commonly in adult
• C. Mostly above cricoid
• D. Mediastinal infection not present

Hint:

A coin seen as a full circle on the AP film lies in the flat oesophagus, not the trachea.

Answer 1

The Correct Option is A

Step 1: Interpret the radiograph. The chest x-ray shows a round, flat radio-opaque foreign body (the classic "coin" appearance) lying in the upper mediastinum. A coin seen en face (full circle on the frontal film) indicates that it is lodged in the oesophagus, because the oesophagus is flattened front-to-back so a flat disc orients its broad face toward the frontal view; a coin in the trachea would instead appear edge-on (a thin line) on the AP film.

Step 2: Evaluate option A. A swallowed coin most commonly impacts at the narrowest point of the oesophagus - the cricopharyngeal/upper oesophageal sphincter (C6 level). The radiographic orientation confirms the oesophagus is the correct site of the foreign body. Hence option A is true and is the answer.

Step 3: Exclude the distractors.
- Most commonly in adult (B): false - oesophageal foreign body / coin ingestion is most common in children (typically 6 months to 3 years), not adults.
- Mostly above cricoid (C): false - the impaction is at/just below the cricopharyngeus (cricopharyngeal narrowing), i.e. at the level of the cricoid, not above it; the food/foreign body lodges in the oesophagus, which begins at the lower border of the cricoid.
- Mediastinal infection not present (D): false as a generalisation - a retained or perforating oesophageal foreign body can erode the wall and cause mediastinitis, a recognised dangerous complication, so one cannot state infection is absent.

Final answer: A. Oesophagus is the correct site.