Answer to the last #DiagnosticDilemma
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The answer to the last Diagnostic Dilemma (A 3-year-old girl presented to the emergency department after she had ingested a metal pendant. She had not vomited and had no pain in her chest. A physical examination was unremarkable. A radiograph of the chest confirmed a heart-shaped foreign body in the proximal thoracic esophagus) is A. Foreign bodies that have been present for longer than 24 hours.

Ingested items that warrant immediate endoscopic removal from the esophagus include sharp objects, button batteries, and foreign bodies that have been present for longer than 24 hours. Asymptomatic children who have ingested items that do not have potentially dangerous features may be observed without intervention to allow the foreign body to pass spontaneously.

In this patient, the position of the foreign body appeared to be unchanged on repeat radiographs of the chest. The patient was taken to the operating room to undergo rigid endoscopy, and a gold heart-shaped pendant was removed. Reinspection of the esophagus showed minor abrasions of the esophageal mucosa. After the procedure, the patient recovered well and was discharged home.

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Source: NEJM
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