The coin was again endoscopically removed. A careful review of these two previous chest radiographs reveals a narrowed tracheal air column best visible on both lateral views. View these CXR's again. An esophageal mass or edema surrounding the foreign body could result in extrinsic compression of the trachea. Once the esophageal coin is removed, it would not be routine to repeat the chest radiographs to examine the caliber of the tracheal air column again.
Clinical examination following the coin removal is generally sufficient.
In this case, the stridor appears to be persistent. The presentation of a child with persistent stridor and the two previous occurrences of a foreign body lodged in the esophagus, suggests intrathoracic compression of both the trachea and the esophagus. The differential diagnosis includes vascular rings or slings, a mediastinal mass, or an intrinsic esophageal tumor or duplication. Another chest radiograph is obtained. These chest radiographs show a normal cardiac silhouette without mediastinal widening, but there is some suggestion of a right-sided aortic arch with slight narrowing of the trachea on the frontal view.