A six year old boy presented to the ED with his father following a witnessed episode of coin swallowing. The father observed the boy swallow "several" coins before he could stop him. The boy "coughed up" several pennies immediately at the home. The boy was not in acute respiratory distress during any portion of the episode and did not vomit. The father brought the boy in for evaluation. The boy complains of a "sore throat" while swallowing and is otherwise without complaints.
1. Lateral (coronal) orientation of coin on PA film. If the coin was in the trachea, we would expect an AP (longitudinal) orientation of the coin secondary to the incomplete rings of the trachea opening posteriorly.
2. Lack of evidence of air trapping or obstruction on both films. (atelectasis, pneumonia, mediastinal shift)
3. Lack of clinical signs of airway compromise. (cough, wheeze, respiratory distress)
4. Location of relatively large object below the level of the larynx.
5. Complete visualization of the intact trachea on the lateral film.
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