Extensive Thoracic Injury From Button Battery Ingestion

A 28-month-old girl presented to the emergency department with a 6-day history of lethargy and refusal to lie supine or walk. A radiograph showed a round object with a halo in the proximal esophagus consistent with a 20-mm lithium battery. The patient was immediately taken to the operating room for removal using rigid esophagoscopy. Significant posterior esophageal edema and tissue damage were noted. An esophagram did not show extravasation of contrast. Magnetic resonance imaging of the chest was significant for a paravertebral inflammatory mass posteromedial to the aortic arch consistent with mediastinitis, as well as discitis and osteomyelitis of the first and second thoracic vertebral bodies (Figs. 1 and 2). The patient underwent serial computed tomography angiography to assess great vessels, which remained immediately adjacent to inflammation but unharmed. Patient was discharged after a 1-month hospital stay with a prolonged course of antibiotics, nothing by mouth, and gastrostomy-tube feedings, as well as a brace to prevent cervical spine flexion/extension. Follow-up imaging showed resolution of mediastinitis, and endoscopy showed mild scarring/stenosis in the proximal esophagus with ability to easily pass neonatal endoscope. Eight months after ingestion the patient is doing well on a full diet and off brace support.FIGURE 1: Axial image from a computed tomography angiogram of the chest demonstrates marked inflammatory changes and phlegmon in the posterior mediastinum (arrows) displacing the vessels and trachea (T) anteriorly and involves the T1–T2 disc space and has resulted in bony destruction of the vertebral body. The esophagus is not discernible in the extensive inflammation.FIGURE 2: Sag T2-weighted sequence of the thoracic spine reveals marrow edema in the vertebral bodies (short arrows) indicative of osteomyelitis and soft tissue infectious mass extending out from the disc (discitis) merging into the anterior paraspinal region where there is already mediastinitis (M).