Immediate Management of a Metallic Battery Overlying the Right Lower Lobe Region
A metallic battery overlying the right lower lobe region represents a medical emergency requiring immediate removal to prevent severe tissue damage and potential life-threatening complications.
Initial Assessment and Stabilization
- Assess airway, breathing, and circulation (ABC)
- Obtain vital signs including oxygen saturation
- Determine time since ingestion/insertion if possible
- Do not delay intervention for extensive imaging if battery position is confirmed
Imaging Considerations
- If not already performed, obtain immediate chest radiograph to:
- Confirm battery location
- Identify battery type/size (button vs. cylindrical)
- Rule out aspiration into the bronchial tree 1
- CT imaging may provide additional information but should not delay removal if battery position is confirmed 1
Immediate Management Algorithm
1. For Confirmed Battery in Bronchus/Lung:
- Immediate bronchoscopy for removal under direct visualization
- Do not attempt blind removal which could cause further tissue damage
- Rigid bronchoscopy is preferred for better control and visualization 1
2. For Battery in Esophagus:
- Emergent endoscopic removal within 2 hours of ingestion/discovery
- Button batteries can cause severe tissue damage in just 2 hours 2
- Risk of esophageal perforation, tracheoesophageal fistulas, and exsanguination if delayed 2
3. For Battery on Chest Wall (External):
- Do not touch with bare hands if battery appears damaged
- Do not use metal instruments for removal
- Gently remove using non-conductive tools (plastic forceps)
- Thoroughly irrigate area with sterile saline
Post-Removal Management
- Assess for tissue damage at the site of contact
- Obtain post-removal imaging to ensure complete removal and assess damage
- Monitor for delayed complications:
- Respiratory distress
- Bleeding
- Signs of infection
- Perforation
- Fistula formation
Special Considerations
- Metal objects create artifacts on CT/MRI that may interfere with precise delineation of surrounding structures 1
- If the battery has been in contact with tissue for >2 hours, expect significant tissue damage 2
- Electric injuries from batteries can cause both direct thermal burns and electrical tissue damage 1
- For multiple casualty situations involving electrical injuries, reverse normal triage priorities (attend to "dead" appearing victims first) 3
Contraindications
- Do not use MRI if metallic foreign body is present or suspected 1
- Do not delay removal for extensive workup if battery position is confirmed
- Do not attempt blind removal without direct visualization
- Do not use metal instruments for removal if battery is externally accessible
Prevention Education
- For patients/families after removal, provide education on battery safety:
- Secure battery compartments in household devices
- Store loose batteries out of reach of children
- Properly dispose of used batteries
- Recognize that 61.8% of batteries ingested by children come directly from products 2
Early recognition and prompt removal of metallic batteries is critical to prevent severe tissue damage and potentially life-threatening complications.