The frontal chest x-ray shows a radioopaque foreign body likely in the oesophagus (round in appearance on frontal view) at the thoracic inlet.

A coin in the oesophagus appears round on the frontal view because oesophagus is flat anteroposteriorly. Whereas if only side of the coin is visible on a frontal chest x-ray, it is likely in trachea as the incomplete cartilaginous rings on the posterior aspect of trachea allow the coin to protrude posteriorly.

The child was transferred to tertiary paediatric facility on a priority basis with a paediatric airway competent specialist and had an uneventful removal of the coin from proximal oesophagus.

Reference: www.emedicine.medscape.com – esophageal foreign body imaging.