Case a. A 30-month-old boy, who is in obvious distress with a barking cough and croup-like symptoms but no fever, is brought by his mother for examination. History is unremarkable except for a recent choking episode. A radiograph is ordered.
Complete obstruction should be treated with back blows in a child aged less than 1 year and abdominal thrusts in an older child. In a more stable child, provide supplemental oxygen and consult a physician skilled in laryngoscopy and bronchoscopy for removal of the foreign body. Esophageal foreign bodies may also cause stridor. In these cases the child will often complain of dysphagia or avoid swallowing.
While some objects, such as coins, can be visualized on plain imaging, a negative film does not rule out a foreign body and a specialist should be consulted for endoscopy. A coin in the trachea will be seen on its edge in an anteroposterior view. In the esophagus, it will generally appear as a full circle (en face) in an anteroposterior oblique view. For the lateral view, it is just the opposite, as seen in the case figure.
For more information, see “Differential Diagnosis of Stridor in Children.” Emergency Medicine. 2009 September;41(9):10-11.