An elusive and often unsuspected cause of stridor or pneumonia (the esophageal foreign body)

Children with esophageal foreign bodies may present with a variety of respiratory symptoms and few, if any, symptoms of esophageal obstruction. Awareness of this presentation by the clinician and radiologist should lead to early diagnosis. This is most important, for if the diagnosis is not secured at an early stage, complications such as esophageal ulceration, esophageal perforation, chronic aspiration pneumonia, and failure to thrive can develop. Early roentgenographic examination of the neck (lateral view with extension and inspiration) and chest is essential and usually all that is needed for the diagnosis. Barium swallow examination may be required in some cases, but potentially hazardous diagnostic procedures such as tracheoscopy and bronchoscopy should be avoided.