The patient was a seven-year-old boy, who came to see me with his mom. She said that he complained of sore throat two days prior and was “spitting up” the “phlegm”. She denied any fever, cough or vomiting up food. She was concerned that her son was not able to eat or drink anything for past two days. The boy was seen on the previous day by a different doctor who examined him and took a throat swab, which showed no strep. During our conversation the boy was sitting on the exam table with a paper cup constantly spitting his saliva in it. He was not coughing and did not appear to be in pain. It looked like he was not able to swallow his saliva. “Does he have an abscess in his throat?” I thought. To my surprise his exam was absolutely unremarkable. He mentioned that his “neck hurts”, and pointed to the front of the neck. I asked the youngster if he remembered choking on something, but got no response.
I advised mom to take him to get X-Ray of his neck and chest immediately, on a suspicion of a foreign body. She did and a quarter was found is his food pipe! The quarter was uneventfully removed by a surgeon at the University of Michigan Hospital.
The lesson that can be learned from this story? — Even older children are capable of doing silly things; if you are dealing with a little child, a possibility of a foreign body should be very high on your list.