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Abdomen » Gastrointestinal
Swallowed coin.
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Author(s) :
Nirvikar Dahiya, MD
 
Presentation This patient is a 10 year old boy who presented with history of swallowing a coin. The x-ray showed a coin in the stomach region. The parents were advised to wait. Three weeks later the patient came back with history of abdominal pain on and off. A repeat x-ray showed the coin to be in the region of the pylorus. An ultrasound was done to rule out any other cause for abdominal pain. We did not expect to see the coin on ultrasound but a persistent echogenic semicircular reflector with posterior attenuation was seen in the region of the pylorus. The margins were very well defined and the possibility of this shadow being the coin was considered. The reflector was measured edge to edge and was about 16mm in diameter. This size was then correlated with Indian coins in circulation and was consistent with the size of a 25 Paisa coin which is about the same size as that of a USA penny coin.
 
 
 
Caption: X-ray
Description: X-ray of the abdomen showing the linear coin shadow.
 
 
 
Caption: X -ray
Description: X-ray abdomen showing the linear coin shadow.
 
 
 
Caption: Ultrasound
Description: Ultrasound with 3.5 MHz probe showed a well defined 16mm echogenic lesion in the antrum. Transverse midline scan.
 
 
 
Caption: Ultrasound
Description: Ultrasound with 10 MHz linear probe showed a well defined 16mm echogenic lesion in the antrum. Transverse midline scan.
 
 
 
Caption: Ultrasound
Description: Ultrasound with 3.5 MHz probe showed a well defined 16mm echogenic lesion in the antrum. Transverse midline scan.
 
 
 
Caption: Endoscopy
Description: Coin seen at endoscopy
 
 
 
Caption: Endoscopy
Description: Retrieval of the coin endoscopically
 
 
 
Caption: Coin
Description: The retrieved coin - A bit eroded and darkened but nonetheless worth its value !
 
Differential Diagnosis None was entertained.


 
Final Diagnosis Endoscopy showed the ingested 25 Paisa Indian Coin. The coin was removed endoscopically.
 
Discussion The case was presented because it was the first time we were able to see a coin shadow in the stomach sonologically. Of course the history of the patient helped us in the diagnosis. The ultrasound measurements could guide us with regards to what type of coin it was. While conventional radiography readily demonstrated the coin, precise determination of actual size would be more difficult because of magnification.
 
Follow Up Patient is doing well.
 
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