PMC7156279_01
Computed tomography showing focal air in the mediastinum suggesting esophageal perforation. (
A
) Axial image:The cathode side faced forward and the BB was tilted slightly clockwise. (
B
) Sagittal image:There was only 1cm between the BB and the Ao. (
C
) Mediastinal window, axial image:Arrowheads indicate focal air in the mediastinum. (
D
) Mediastinal window, sagittal image:Arrowheads indicate focal air in the mediastinum. Ao, aorta; BB, button battery; E, esophagus; T, trachea.
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FI190478cr-1
Computed tomography (CT) showed focal air in the mediastinum suggesting esophageal perforation ( Fig. 1 ).
(
A
) Fluoroscopy at the time of referral arrowheads indicated a lithium BB impacted the upper esophagus. (
B
) Contrast fluoroscopy on 8 days after retrieval. Arrowheads indicate contrast agent flowing into the trachea. (
C
) Flexible endoscopy on 15 days after retrieval. Flexible esophagostomy revealed TEF formation, 6 mm in diameter. (
D
) Endoscopy on 28 days after retrieval. Spontaneous closure of TEF was confirmed. E, esophagus; TEF, tracheoesophageal fistula.
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FI190478cr-2
Emergency rigid laryngoscopy was performed under general anesthesia and identified a 20 mm 3V LBB lodged in the upper esophagus ( Fig. 2A ).  Follow-up esophagoscopy and contrast study on day 8 after retrieval demonstrated an acquired TEF ~6 mm in diameter at the site where LBB had been impacted ( Fig. 2B , C ). After 28 days of careful conservative management, spontaneous closure of the TEF was confirmed by esophagoscopy and esophagography ( Fig. 2D ).