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Spondylodiscitis complicated by the ingestion of a button battery: a case report.

Sudhakar PJ, Al Dossary J, Malik N - Korean J Radiol (2008 Nov-Dec)

Bottom Line: A one-and-a-half year old boy who presented with a cough, irritability, and refusal of food was found to have an impacted foreign body in his upper esophagus.We present the radiologic findings of the foreign body (a button battery) impacted in the upper esophagus and its complications; namely, mediastinitis and spondylodiscitis after endoscopic removal.Further, plain radiograph and MR imaging findings are discussed along with literature review.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Salmaniya Medical Complex, Kingdom of Bahrain. pjsudhakar@rediffmail.com

ABSTRACT
A one-and-a-half year old boy who presented with a cough, irritability, and refusal of food was found to have an impacted foreign body in his upper esophagus. We present the radiologic findings of the foreign body (a button battery) impacted in the upper esophagus and its complications; namely, mediastinitis and spondylodiscitis after endoscopic removal. Further, plain radiograph and MR imaging findings are discussed along with literature review.

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Related in: MedlinePlus

Spondylodiscitis in a child.A. Plain chest film demonstrates foreign body (button battery) in superior mediastinum. Bilateral chest tubes were inserted to relieve pneumothorax, which had developed during endoscopic extraction.B-D. T2- (B), T1-weighted (C) and contrast-enhanced T1-weighted sagittal image (D) showing T1-2 spondylodiscitis with pre-vertebral extension.E-G. T2-weighted axial image (E) demonstrates diffuse hyperintensity in mediastinal planes. Pre- (F) and contrast-enhanced T1-weighted axial image (G) revealed diffuse enhancement in mediastinum suggesting mediastinitis.
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Figure 1: Spondylodiscitis in a child.A. Plain chest film demonstrates foreign body (button battery) in superior mediastinum. Bilateral chest tubes were inserted to relieve pneumothorax, which had developed during endoscopic extraction.B-D. T2- (B), T1-weighted (C) and contrast-enhanced T1-weighted sagittal image (D) showing T1-2 spondylodiscitis with pre-vertebral extension.E-G. T2-weighted axial image (E) demonstrates diffuse hyperintensity in mediastinal planes. Pre- (F) and contrast-enhanced T1-weighted axial image (G) revealed diffuse enhancement in mediastinum suggesting mediastinitis.

Mentions: A one and-a-half year old boy was presented to the emergency department with a four day history of coughing, repeated vomiting, irritability and refusal of food. His symptoms began after returning from a picnic. The boy had no prior history of breathing difficulties or cyanosis. A medical examination revealed that the boy had a low grade fever and a few crepitations in the left lower chest. A chest radiograph (Fig. 1A) revealed a rounded, coin-like foreign body at the cervicothoracic junction. An endoscopy performed under general anaesthesia revealed a foreign body in the upper esophagus at 15 cm from the incisors. The button battery was partially embedded in the esophageal wall, which was edematous and ulcerated with charred tissues around the foreign body. During manipulation, the patient's blood oxygen saturation level dropped, which suggested that signs of pneumothorax were present and this prompted the insertion of bilateral chest tubes. As a result, the patient's oxygen saturation level improved and the bilateral air entry was confirmed by a chest radiograph. Following a difficult manipulation, a lithium button battery was removed from the patient. The battery shell remained intact without signs of leakage. Regardless, the patient was kept on nasogastric tube feeds and broad spectrum antibiotic coverage. Ten days after the procedure, a gastrograffin esophagogram was performed, which did not reveal any evidence of a leak. Consequently, the patient was started on oral feeds and was discharged two days later, however was readmitted almost six weeks later, with complaints of neck pain, stiffness, restricted neck movement and intermittent fever since the previous two weeks. The MR imaging (Fig. 1B-D) showed evidence of spondylodiscitis involving the T1-2 disc with enhancing endplates and extension of the enhancing granulation tissues into the prevertebral region. In addition, narrowing of the tracheal lumen was also noted at this level. Also, there was diffuse enhancement in the prevertebral soft tissues around the esophagus, trachea and mediastinal planes, which suggested mediastinitis (Fig. 1E-G). A gastrograffin esophagogram had not revealed any obvious leakage; however, the patient did improve with antibiotics and was afebrile, free of pain and had improved neck movement at the time of discharge.


Spondylodiscitis complicated by the ingestion of a button battery: a case report.

Sudhakar PJ, Al Dossary J, Malik N - Korean J Radiol (2008 Nov-Dec)

Spondylodiscitis in a child.A. Plain chest film demonstrates foreign body (button battery) in superior mediastinum. Bilateral chest tubes were inserted to relieve pneumothorax, which had developed during endoscopic extraction.B-D. T2- (B), T1-weighted (C) and contrast-enhanced T1-weighted sagittal image (D) showing T1-2 spondylodiscitis with pre-vertebral extension.E-G. T2-weighted axial image (E) demonstrates diffuse hyperintensity in mediastinal planes. Pre- (F) and contrast-enhanced T1-weighted axial image (G) revealed diffuse enhancement in mediastinum suggesting mediastinitis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627235&req=5

Figure 1: Spondylodiscitis in a child.A. Plain chest film demonstrates foreign body (button battery) in superior mediastinum. Bilateral chest tubes were inserted to relieve pneumothorax, which had developed during endoscopic extraction.B-D. T2- (B), T1-weighted (C) and contrast-enhanced T1-weighted sagittal image (D) showing T1-2 spondylodiscitis with pre-vertebral extension.E-G. T2-weighted axial image (E) demonstrates diffuse hyperintensity in mediastinal planes. Pre- (F) and contrast-enhanced T1-weighted axial image (G) revealed diffuse enhancement in mediastinum suggesting mediastinitis.
Mentions: A one and-a-half year old boy was presented to the emergency department with a four day history of coughing, repeated vomiting, irritability and refusal of food. His symptoms began after returning from a picnic. The boy had no prior history of breathing difficulties or cyanosis. A medical examination revealed that the boy had a low grade fever and a few crepitations in the left lower chest. A chest radiograph (Fig. 1A) revealed a rounded, coin-like foreign body at the cervicothoracic junction. An endoscopy performed under general anaesthesia revealed a foreign body in the upper esophagus at 15 cm from the incisors. The button battery was partially embedded in the esophageal wall, which was edematous and ulcerated with charred tissues around the foreign body. During manipulation, the patient's blood oxygen saturation level dropped, which suggested that signs of pneumothorax were present and this prompted the insertion of bilateral chest tubes. As a result, the patient's oxygen saturation level improved and the bilateral air entry was confirmed by a chest radiograph. Following a difficult manipulation, a lithium button battery was removed from the patient. The battery shell remained intact without signs of leakage. Regardless, the patient was kept on nasogastric tube feeds and broad spectrum antibiotic coverage. Ten days after the procedure, a gastrograffin esophagogram was performed, which did not reveal any evidence of a leak. Consequently, the patient was started on oral feeds and was discharged two days later, however was readmitted almost six weeks later, with complaints of neck pain, stiffness, restricted neck movement and intermittent fever since the previous two weeks. The MR imaging (Fig. 1B-D) showed evidence of spondylodiscitis involving the T1-2 disc with enhancing endplates and extension of the enhancing granulation tissues into the prevertebral region. In addition, narrowing of the tracheal lumen was also noted at this level. Also, there was diffuse enhancement in the prevertebral soft tissues around the esophagus, trachea and mediastinal planes, which suggested mediastinitis (Fig. 1E-G). A gastrograffin esophagogram had not revealed any obvious leakage; however, the patient did improve with antibiotics and was afebrile, free of pain and had improved neck movement at the time of discharge.

Bottom Line: A one-and-a-half year old boy who presented with a cough, irritability, and refusal of food was found to have an impacted foreign body in his upper esophagus.We present the radiologic findings of the foreign body (a button battery) impacted in the upper esophagus and its complications; namely, mediastinitis and spondylodiscitis after endoscopic removal.Further, plain radiograph and MR imaging findings are discussed along with literature review.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Salmaniya Medical Complex, Kingdom of Bahrain. pjsudhakar@rediffmail.com

ABSTRACT
A one-and-a-half year old boy who presented with a cough, irritability, and refusal of food was found to have an impacted foreign body in his upper esophagus. We present the radiologic findings of the foreign body (a button battery) impacted in the upper esophagus and its complications; namely, mediastinitis and spondylodiscitis after endoscopic removal. Further, plain radiograph and MR imaging findings are discussed along with literature review.

Show MeSH
Related in: MedlinePlus