Diagnostic Considerations
Important considerations
A strategy to avoid misdiagnosis remains elusive because patient presentation generally suggests other more common diagnosis for which radiographs are not usually indicated. Misdiagnosis of disk batteries as coins on radiographs can generally be prevented by with an anteroposterior or posteroanterior, view along with a lateral view of the ingested battery. Conversely, ingestion of two coins may be initially misdiagnosed as a disk battery (see images below).
Lateral chest radiograph of a child with a nickel and penny adhered to each other in the upper esophagus initially misdiagnosed as a disk battery.
Endoscopic view of a nickel and penny in the esophagus of a child that was initially misdiagnosed as a disc battery.
Special concerns
The National Button Battery Ingestion Hotline (202-625-3333) was established in 1982 at Georgetown University Hospital's National Capital Poison Center and functions as an emergency consultation service and case registry.
Disk batteries placed in the ear have been reported to cause the following:
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Tympanic membrane perforation
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Skin necrosis in the external auditory canal
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Dysacusis from ossicle destruction
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Facial nerve paralysis
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Chondritis
Nasal septal perforation with resultant saddle deformity has been reported after disk battery placement in the nose. The clinical presentation of a nasal disk battery is usually unilateral nasal discharge with or without features of a secondary infection. Early recognition and removal of the battery is important to prevent adverse sequelae.
Differential Diagnoses
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Cross-section of a typical disk battery.
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Exposures to disk batteries reported to the American Association of Poison Control Centers, 1986-2009.
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Lateral radiographic appearance of a 7.9-mm disk battery. Photographed by Daniel J. Dire, MD.
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Recommended management algorithm for patients with disk battery ingestions. Notes: (1) Serum mercury levels and chelation therapy should be reserved for patients who develop signs of mercury toxicity, not simply because mercury is noted on radiograph. (2) Acute abdomen, tarry or bloody stools, fever, and persistent vomiting. (3) Disk batteries in the esophagus must be removed. Endoscopy should be used if available. The Foley catheter technique may be used if the ingestion is less than 2 hours old but not if more than 2 hours old because it may increase the damage to the weakened esophagus. (4) When the Foley technique fails or is contraindicated, the disk battery should be removed endoscopically. This may require transfer to a more comprehensive medical treatment facility.
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Radiograph of child 1 week after ingestion of a disk battery. The battery has passed into the rectum. Photographed by Daniel J. Dire, MD.
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Disk battery in the stomach of an 18-month-old child.
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Changes in the diameter of disk batteries ingested from 1990-2008.
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Changes in chemical systems of ingested disk batteries from 1990-2008.
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Endoscopic view of disk battery in esophagus of a child demonstrating esophageal burns.
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Endoscopic view of a nickel and penny in the esophagus of a child that was initially misdiagnosed as a disc battery.
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Lateral chest radiograph of a child with a nickel and penny adhered to each other in the upper esophagus initially misdiagnosed as a disk battery.
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20 mm CR 2032 lithium cell disk battery shown with a U.S. quarter: On the left is the cathode (positive pole) and on the right the narrower anode (negative pole).
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NPDS button-battery ingestion frequency and severity (for moderate, major, and fatal outcomes), according to year.
