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Emerg Med J doi:10.1136/emermed-2013-202640
  • Images in emergency medicine

Calcichew tablet causing oesophageal obstruction and aspiration pneumonia

  1. Ben Lovell
  1. Correspondence to Dr Ben Lovell, Medical Admissions Unit, Royal Free Hospital NHS Foundation Trust, Pond Street, London, UK; benlovell{at}doctors.org.uk
  • Accepted 26 March 2013
  • Published Online First 10 April 2013

An 86-year-old man presented with new dysphagia and regurgitation of solids and liquids. His past medical history included a mild cognitive defect, type 2 diabetes, hypertension, osteoporosis and aortic valve disease.

On examination, he was afebrile, and blood pressure and pulse rate were normal. His oxygen saturations on room air were 94% and auscultation of the chest showed crepitations in the left lower zone. His white cell count was 14.4×109/l and C-reactive protein was 194 mg/dl.

An initial plain chest radiograph showed a round dense object close to the left hilum (figure 1). Left lower zone consolidation was seen, in keeping with infection. The patient strongly denied ingesting any foreign objects. A chest radiograph performed the following day showed that the object had split into two halves (figure 2). An oesophageogastroduodenoscopy was performed, and a Calcichew tablet was retrieved from the mid-oesophagus.

Figure 1

Chest radiograph showing a round dense object in the oesophagus.

Figure 2

Chest radiograph showing the dense object has split into two pieces.

The patient admitted that he had been swallowing his Calcichew tablets whole, with his other morning medication, and was unaware that it should be chewed. He responded well to antibiotic treatment and was discharged. Clear instructions should be given to patients who take multiple drugs, especially if there is an element of cognitive decline.

Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.